| Pinelake Physician Practice, Llc | |
|
101 Main St Fulton KY 42041-1601 | |
| (270) 472-5245 | |
| (270) 472-5249 |
| Full Name | Pinelake Physician Practice, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 101 Main St, Fulton, Kentucky |
| Authorized Official Name and Position | Sharlee Lebleu (SR DIRECTOR, PROVIDER ENROLLMENT) |
| Authorized Official Contact | 6159207192 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pinelake Physician Practice, Llc 330 Seven Springs Way Brentwood TN 37027-5098 Ph: (615) 920-7000 | Pinelake Physician Practice, Llc 101 Main St Fulton KY 42041-1601 Ph: (270) 472-5245 |
| NPI Number | 1437623337 |
|---|---|
| Provider Enumeration Date | 01/14/2019 |
| Last Update Date | 06/11/2019 |
| Medicare PECOS PAC ID | 6800797507 |
|---|---|
| Medicare Enrollment ID | O20170721003041 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437623337 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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