Organization
PINELAKE PHYSICIAN PRACTICE, LLC
Active
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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