Pinelake Physician Practice, LLC

NPI #1437623337 in Fulton, Kentucky

Provider Information

NPI Number
1437623337
Entity Type
Organization
Organization Name
Pinelake Physician Practice, LLC
Primary Specialty
Clinic/Center - Rural Health
Enumeration Date
Jan 14, 2019
Last Updated
Jun 11, 2019

Practice Location

Address
101 MAIN ST
City
Fulton
ZIP Code
42041-1601
Phone
(270) 472-5245

Authorized Official

Name
SHARLEE LEBLEU
Title
SR DIRECTOR, PROVIDER ENROLLMENT
Phone
(615) 920-7192

Specialties & Taxonomy Codes

Specialty
Clinic/Center - Rural HealthRural Health

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