PINELAKE PHYSICIAN PRACTICE LLC is an otolaryngology/facial plastic surgery otolaryngology in Mayfield, KY. The provider is an otolaryngologist who specializes in the diagnosis and surgical treatment of head and neck conditions. PINELAKE PHYSICIAN PRACTICE LLC NPI is 1255650479. The provider is registered as an organization entity type and is a multiple single specialty group. The provider Is Doing Business As Jackson Purchase Ent & Aesthetic Surgery.
The provider's business location address is:
1111 MEDICAL CENTER CIR MAYFIELD, KY ZIP 42066-194 Phone: (270) 251-4080 Fax: (270) 251-4081
The provider's authorized official is Timothy D Vaughn . The authorized official title is Vice President and has the following contact phone number (615) 372-8500.
The CLIA number assigned to this NPI record is 18D2010708 - physician office with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 5/27/2010 and was last updated on 5/27/2010.
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.
This page was last updated on: 11/21/2025
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