Organization
PINELAKE PHYSICIAN PRACTICE LLC
Active
Other names
Jackson Purchase Family and Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DENIS MILLER (REGIONAL DIRECTOR)
(615) 934-1454
Entity
Organization
Contact information
Practice address
1111 MEDICAL CENTER CIR, MAYFIELD, KY 42066-1194
(270) 251-4085
(270) 251-4086
Mailing address
1029 MEDICAL CENTER CIR, MAYFIELD, KY 42066-1189
(270) 251-4547
(270) 251-4546
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
Other
Enumeration date
09/30/2010
Last updated
09/30/2010
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