PINELAKE PHYSICIAN PRACTICE, LLC (NPI# 1295960532) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295960532 |
| Entity Type | Organization |
| Organization Name | PINELAKE PHYSICIAN PRACTICE, LLC |
| Practice Address |
1111 Medical Center Cir Mayfield KY 42066-1194 |
| Mailing Address |
330 Seven Springs Way Atten: Provider Enrollment Brentwood TN 37027-5098 |
| Practice Telephone | 2702514543 |
| Practice Fax Number | 2702514544 |
| Mailing Telephone | 6159207192 |
| Mailing Fax Number | 6159208775 |
| Enumeration Date | 2009-05-15 |
| Last Update Date | 2019-05-14 |
| Authorized Official Name | SHARLEE LEBLEU (SR. DIRECTOR) |
| Authorized Official Telephone | 6159207192 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 7100335050 | 05 | |
| KY | ANTHEM | 000000618910 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 101 Main St, Fulton, KY 420411601 | 2704725245 | 2704725249 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437623337 | Pinelake Physician Practice, LLC | Clinic/Center | 101 Main St, Fulton, KY 42041-1601 | 2019-01-14 |
| 1942535281 | Pinelake Physician Practice, LLC | Durable Medical Equipment & Medical Supplies | 1111 Medical Center Cir, Mayfield, KY 42066-1194 | 2009-10-05 |
| 1972738839 | Pinelake Physician Practice, LLC | Surgery | 1111 Medical Center Cir, Mayfield, KY 42066-1194 | 2009-05-21 |
| 1861563439 | Pinelake Physician Practice, LLC | Family Medicine | 2003 S 7th St, Hickman, KY 42050-1841 | 2006-11-13 |
| Street Address |
1111 MEDICAL CENTER CIR |
| City | MAYFIELD |
| State | KY |
| Zip Code | 42066-1194 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538162458 | Joseph C. Slaughter | Internal Medicine | 1111 Medical Center Cir, Mayfield, KY 42066-1194 | 2005-05-24 |
| 1992254288 | Jackson Purchase Pulmonary Medicine Pllc | Nurse Practitioner | 1111 Medical Center Cir, Mayfield, KY 42066-1194 | 2016-09-27 |
| 1114383981 | Jennifer L Carrico | Nurse Practitioner | 1111 Medical Center Cir, Mayfield, KY 42066-1194 | 2016-01-11 |
| 1902189491 | Michelle Ann Jewell | Nurse Practitioner | 1111 Medical Center Cir, Mayfield, KY 42066 | 2011-09-21 |
| 1912216532 | Pinelake Physician Practice LLC | Family Medicine | 1111 Medical Center Cir, Mayfield, KY 42066-1194 | 2010-09-30 |
| 1104147891 | Siddharth Patel | Pediatrics | 1111 Medical Center Cir, Mayfield, KY 42066-1194 | 2010-06-16 |
| 1255650479 | Pinelake Physician Practice LLC | Otolaryngology | 1111 Medical Center Cir, Mayfield, KY 42066-1194 | 2010-05-27 |
| 1942535281 | Pinelake Physician Practice, LLC | Durable Medical Equipment & Medical Supplies | 1111 Medical Center Cir, Mayfield, KY 42066-1194 | 2009-10-05 |
| 1346478344 | Pooja Parshotam Makhija | Pediatrics | 1111 Medical Center Cir, Mayfield, KY 42066-1194 | 2009-06-29 |
| 1972738839 | Pinelake Physician Practice, LLC | Surgery | 1111 Medical Center Cir, Mayfield, KY 42066-1194 | 2009-05-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760031959 | Snh Derby Tenant LLC | Assisted Living Facility | 1517 West Broadway Street, Mayfield, KY 42066 | 2019-09-10 |
| 1033674254 | Mind, Body, Soul, LLC | Clinic/Center | 1325 Us 45 S, Suite C, Mayfield, KY 42066 | 2019-02-01 |
| 1699288936 | Kimberly Kaye Gooch | Developmental Therapist | 3907 State Route 303, Mayfield, KY 42066 | 2017-11-08 |
| 1538604657 | Courtney L Coleman | Nurse Practitioner | 1029 Medical Center Cir Ste 200, Mayfield, KY 42066 | 2016-12-28 |
| 1659814721 | Bertha Workman | Voluntary or Charitable | 331 South 7th Street, Mayfield, KY 42066 | 2016-11-22 |
| 1699174052 | Laura Dassing | Counselor | 1325 Hwy 45 N, Mayfield, KY 42066 | 2014-08-21 |
| 1275947905 | Wkda Services LLC | Community/Behavioral Health | 1325 U S Hwy 45n, Mayfield, KY 42066 | 2014-06-20 |
| 1538594247 | Young Healthcare LLC | Chiropractor | 1011 Paris Road #341, Mayfield, KY 42066 | 2013-09-12 |
| 1811335649 | Donald Bennett Dowdy | Dentist | 236 N. 6th St., Mayfield, KY 42066 | 2013-06-14 |
| 1578822623 | Wanda Bingham Marshall | Counselor | 325 South 8th Street, West Kentucky Counseling Center, Mayfield, KY 42066 | 2012-05-10 |
| Find all providers in zip 42066 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922645134 | Pinelake Physician Practice LLC | Clinic/Center | 417 S 6th St, Mayfield, KY 42066-2311 | 2019-12-06 |
| 1275178089 | Pinelake Physician Practice LLC | Clinic/Center | 417 S 6th St, Mayfield, KY 42066-2311 | 2019-11-15 |
| 1679061071 | Pinelake Physician Practice LLC | Clinic/Center | 110 S 9th St, Mayfield, KY 42066-2208 | 2018-05-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669072757 | Arh Mary Breckinridge Health Services, Inc. | Clinic/Center | 302 Walnut Street, Pineville, KY 40977 | 2020-10-28 |
| 1316553167 | Flaget Healthcare Inc | Clinic/Center | 2387 Main St, Willisburg, KY 40078-8102 | 2020-09-17 |
| 1710590880 | Flaget Healthcare, Inc | Clinic/Center | 4359 Shepherdsville Road, Ste 255, Bardstown, KY 40004 | 2020-08-28 |
| 1649881335 | Emerald Therapy Center, LLC | Clinic/Center | 111 Poplar St, Murray, KY 42071-2571 | 2020-08-14 |
| 1407472319 | Family Health Care Associates 7 Limited Liability Company | Clinic/Center | 422 N Highway 27, Whitley City, KY 42653 | 2020-06-17 |
| 1154950699 | Family Health Care Associates 6 Limited Liability Company | Clinic/Center | 8070 Us Highway 60 W, Lewisport, KY 42351-7087 | 2020-04-06 |
| 1568098838 | Appalachian Regional Healthcare, Inc | Clinic/Center | 186 Breanna Blvd, Suite 100, Salyersville, KY 41465-7525 | 2020-03-19 |
| 1780217794 | Family Health Care Associates 5 Limited Liability Company | Clinic/Center | 74 H&b Partin Lane, Pineville, KY 40977 | 2020-02-18 |
| 1023649514 | Memorial Hospital Inc | Clinic/Center | 485 Memorial Dr Ste 1, Manchester, KY 40962-9111 | 2020-02-03 |
| 1265072946 | Baptist Health Medical Group Inc | Clinic/Center | 800 Hospital Dr Fl 2, Madisonville, KY 42431-1658 | 2020-01-10 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on PINELAKE PHYSICIAN PRACTICE, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.