PINELAKE PHYSICIAN PRACTICE LLC NPI 1912216532

NPI Information

  • NPI: 1912216532
  • Provider Name: PINELAKE PHYSICIAN PRACTICE LLC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Doing Business As: JACKSON PURCHASE FAMILY AND SPORTS MEDICINE
  • Address: 1111 MEDICAL CENTER CIR
    MAYFIELD, KY
    ZIP 42066
  • Phone: (270) 251-4085

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NPI Details

PINELAKE PHYSICIAN PRACTICE LLC is a family medicine in Mayfield, KY. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. PINELAKE PHYSICIAN PRACTICE LLC NPI is 1912216532. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Jackson Purchase Family And Sports Medicine.

The provider's business location address is:

1111 MEDICAL CENTER CIR
MAYFIELD, KY
ZIP 42066-194
Phone: (270) 251-4085
Fax: (270) 251-4086

The provider's authorized official is Denis Miller .
The authorized official title is Regional Director and has the following contact phone number (615) 934-1454.

The enumeration date for this NPI number is 9/30/2010 and was last updated on 9/30/2010.

Taxonomy Codes

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:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207QS0010XFamily MedicineSports MedicineNo
2207Q00000XFamily MedicineYes

What is NPI?

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This page was last updated on: 3/30/2025

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