Provider Demographics
NPI:1144491671
Name:PAINTSVILLE HMA PHYSICIAN MANGAMENT
Entity type:Organization
Organization Name:PAINTSVILLE HMA PHYSICIAN MANGAMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-789-6844
Mailing Address - Street 1:609 JAMES TRIMBLE BLVD
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-1055
Mailing Address - Country:US
Mailing Address - Phone:606-789-6844
Mailing Address - Fax:606-789-4157
Practice Address - Street 1:609 JAMES TRIMBLE BLVD
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1055
Practice Address - Country:US
Practice Address - Phone:606-789-6844
Practice Address - Fax:606-789-4157
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH MANAGEMENT ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19716207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65946113Medicaid
KY00054Medicare PIN