Organization Name:  MEDICAL INVESTMENT TRUST


Practice Location:
156 ISLAND CREEK RD  PIKEVILLE, KY 41501 US
Tel: 606-432-0174  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
N	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Family	KY	3001627
Y	207K00000X	Physicians Allergy & Immunology	KY	17816

Other Provider Identifiers:

Issuer	Number	State	Type
	65-922866	KY	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin