| Pinelake Physician Practice Llc | |
|
2003 S 7th St Hickman KY 42050-1841 | |
| (270) 236-3337 | |
| (270) 236-3340 |
| Full Name | Pinelake Physician Practice Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2003 S 7th St, Hickman, Kentucky |
| Authorized Official Name and Position | Terrance K. Dillon (ASSISTANT SECRETARY) |
| Authorized Official Contact | 5025967220 |
| 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) 920-7780 | Pinelake Physician Practice Llc 2003 S 7th St Hickman KY 42050-1841 Ph: (270) 236-3337 |
| NPI Number | 1205494085 |
|---|---|
| Provider Enumeration Date | 06/05/2019 |
| Last Update Date | 08/24/2022 |
| Medicare PECOS PAC ID | 6800797507 |
|---|---|
| Medicare Enrollment ID | O20160525000413 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205494085 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Parkway Regional Medical Clinic, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2003 S 7th St, Hickman, KY 42050 Phone: 270-236-3202 Fax: 270-236-9597 | |
Hospital Of Fulton, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2003 S 7th St, Hickman, KY 42050 Phone: 270-236-3202 Fax: 270-236-9597 | |
Hospital Of Fulton Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2003 S 7th St, Hickman, KY 42050 Phone: 270-236-3202 Fax: 270-236-9597 |