NPIMap

Organization Active NPI

Pineville Community Hospital Assn Inc

  • Internal Medicine Physician
  • Pineville, KY
National Provider Identifier
1801069315
Registry record updated Sep 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
100020 Issued in KY
Legal business name
PINEVILLE COMMUNITY HOSPITAL ASSN INC
Practice address
850 Riverview Ave
Pineville, KY 40977-1430
Phone
(606) 337-3051
Fax
(606) 337-2871
NPI assigned
Apr 4, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Matthew Brock
Title
Ceo
Phone
(606) 337-3051

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 100020 KY Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X
Women's Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LW0102X

Addresses

Primary practice location

850 Riverview Ave
Pineville, KY 40977-1430

Mailing address

850 Riverview Ave
Pineville, KY 40977-1430
Phone (606) 337-3051

Other identifiers 2

IdentifierTypeStateIssuer
01011352MedicaidKY
180021OtherKYMEDICARE ID

Other names 1

  • PCH MEDICAL CLINIC Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505952000000",
    "number": "1801069315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 RIVERVIEW AVE",
            "city": "PINEVILLE",
            "state": "KY",
            "postal_code": "409771430",
            "telephone_number": "606-337-3051",
            "fax_number": "606-337-2871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 RIVERVIEW AVE",
            "city": "PINEVILLE",
            "state": "KY",
            "postal_code": "409771430",
            "telephone_number": "606-337-3051",
            "fax_number": "606-337-2871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINEVILLE COMMUNITY HOSPITAL ASSN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-04",
        "last_updated": "2017-09-21",
        "status": "A",
        "authorized_official_last_name": "BROCK",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "606-337-3051",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "100020",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Women's Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01011352",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "180021",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PCH MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pineville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.