Provider Demographics
NPI:1215984711
Name:SALYERSVILLE MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:SALYERSVILLE MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DJIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-794-5600
Mailing Address - Street 1:PO BOX 2688
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2688
Mailing Address - Country:US
Mailing Address - Phone:606-432-2748
Mailing Address - Fax:606-437-0438
Practice Address - Street 1:268 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:SALYERSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41465-8032
Practice Address - Country:US
Practice Address - Phone:606-349-5300
Practice Address - Fax:606-349-5312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008377363LF0000X
KY3007841363LF0000X, 363LF0000X
KY900116261QR1300X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100315420Medicaid
KY7100315420Medicaid
KY5367Medicare PIN