JACKSON PURCHASE ENT & AESTHETIC SURGERY
NPI 1255650479
Otolaryngology - Otolaryngology/Facial Plastic Surgery in Mayfield, KY

Q: What is the provider's specialty?

The provider's specialty is Otolaryngology with taxonomy code 207YX0905X and a focus in Otolaryngology/Facial Plastic Surgery.

Active since May 27, 2010CLIA 18D2010708 · Waiver

1111 MEDICAL CENTER CIR, MAYFIELD, KY 42066(270) 251-4080(270) 251-4081 Get Directions Write a Review

NPPES record last updated: May 27, 2010. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Jackson Purchase Ent & Aesthetic Surgery NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACKSON PURCHASE ENT & AESTHETIC SURGERY (NPI 1255650479) is a healthcare organization registered as an otolaryngology/facial plastic surgery in Mayfield, Kentucky and active in the NPI registry since May 2010. The organization holds a CLIA Waiver certificate valid through August 2, 2026 and lists Timothy D Vaughn, Vice President, as its authorized official.

NPPES Registry Identity

NPI1255650479

Entity TypeOrganization

Primary Taxonomy207YX0905X

Legal Business NamePINELAKE PHYSICIAN PRACTICE LLC

Location Address1111 MEDICAL CENTER CIRMayfield, KY 42066-1194

Mailing Address1029 Medical Center CirMayfield, KY 42066-1189 · (270) 251-4080 · Fax (270) 251-4081

Phone(270) 251-4080

Fax(270) 251-4081

Organization SubpartNo

Authorized OfficialTimothy D VaughnVice President · (615) 372-8500

Enumeration DateMay 27, 2010

✔ NPI 1255650479 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOtolaryngology · Otolaryngology/Facial Plastic SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code207YX0905X

Definition

An otolaryngologist who specializes in the diagnosis and surgical treatment of head and neck conditions.

1111 MEDICAL CENTER CIR, Mayfield, KY 42066

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Other Names 1

Doing Business AsJackson Purchase Ent & Aesthetic Surgery

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 18D2010708

Jackson Purchase Ent & Aesthetic Surgery · Mayfield, KY

Active · expires Aug 2, 2026

CLIA Number18D2010708

Laboratory TypePhysician Office

Certificate Effective DateAugust 3, 2024

Certificate Expiration DateAugust 2, 2026

Laboratory DirectorRudolph J. Triana

Laboratory Phone(270) 251-4080

Laboratory LocationJackson Purchase Ent & Aesthetic Surgery1111 Medical Center Circle, Mayfield, KY 42066

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JOSEPH C. SLAUGHTER MD

Internal Medicine