JACKSON PURCHASE ENT & AESTHETIC SURGERY – NPI #1255650479
Otolaryngology
An otolaryngologist who specializes in the diagnosis and surgical treatment of head and neck conditions.
JACKSON PURCHASE ENT & AESTHETIC SURGERY is an otolaryngologist located in MAYFIELD, KY. NPPES has assigned the NPI number 1255650479 to JACKSON PURCHASE ENT & AESTHETIC SURGERY on May 27, 2010. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “JACKSON PURCHASE ENT & AESTHETIC SURGERY” is a dba name, the actual legal business name for this organization is PINELAKE PHYSICIAN PRACTICE LLC. The primary taxonomy selected by this provider is 207YX0905X from the Health Care Provider Taxonomy code set, which is classified as Otolaryngology, specializing in Otolaryngology/Facial Plastic Surgery
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NPI Profile for
PINELAKE PHYSICIAN PRACTICE LLC
(more than 16 years ago)
MAYFIELD, KY 42066-1194 Phone: (270) 251-4080 Fax: (270) 251-4081
MAYFIELD, KY 42066-1189 Phone: (270) 251-4080 Fax: (270) 251-4081
VICE PRESIDENT
Phone: (615) 372-8500
A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.
| Taxonomy Classification / Specialization | State | License |
|---|---|---|
| 207YX0905X - Otolaryngology / Otolaryngology/Facial Plastic Surgery (Primary) |
The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.