Organization
PEDIATRIC ASSOCIATES
Active
Organization
PEDIATRIC ASSOCIATES
Active
Other names
Pediatric Associates of Pikeville, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DJIEN HWAT SO (ADMINISTRATOR)
(606) 432-3221
Entity
Organization
Contact information
Practice address
156 ISLAND CREEK ROAD, PIKEVILLE, KY 41501
(606) 432-3221
(606) 437-0438
Mailing address
PO BOX 2748, PIKEVILLE, KY 41502-2748
(606) 432-3221
(606) 437-0438
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
42956
KY
261QR1300X
Rural Health Clinic/Center
Primary
900119
KY
363LF0000X
Family Nurse Practitioner
3006127
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18-3880
RURAL HEALTH PALMETTO
KY
05
—
35001205
—
KY
Enumeration date
05/28/2006
Last updated
03/27/2019
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