Organization
PINELAKE PHYSICIAN PRACTICE, LLC
Active
Other names
Mayfield Orthopedic Associates
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY VAUGHN (VICE PRESIDENT)
(615) 565-1513
Entity
Organization
Contact information
Practice address
1111 MEDICAL CENTER CIR, MAYFIELD, KY 42066-1194
(270) 251-4070
(270) 251-4074
Mailing address
1029 MEDICAL CENTER CIR, MAYFIELD, KY 42066-1189
(270) 251-4547
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
10/05/2009
Last updated
11/23/2010
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