Pinelake Physician Practice LLC

NPI #1255650479 in Mayfield, Kentucky

Provider Information

NPI Number
1255650479
Entity Type
Organization
Organization Name
Pinelake Physician Practice LLC
Primary Specialty
Otolaryngology - Otolaryngology/Facial Plastic Surgery
Enumeration Date
May 27, 2010
Last Updated
May 27, 2010

Practice Location

Address
1111 MEDICAL CENTER CIR
ZIP Code
42066-1194
Phone
(270) 251-4080

Authorized Official

Name
TIMOTHY D VAUGHN
Title
VICE PRESIDENT
Phone
(615) 372-8500

Specialties & Taxonomy Codes

Specialty
Otolaryngology - Otolaryngology/Facial Plastic SurgeryOtolaryngology/Facial Plastic Surgery

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