Healthcare Provider Details

I. General information

NPI: 1366210593
Provider Name (Legal Business Name): MOUNTAIN COMPREHENSIVE HEALTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 KY HIGHWAY 699
CORNETTSVILLE KY
41731-8749
US

IV. Provider business mailing address

PO BOX 40
WHITESBURG KY
41858-0040
US

V. Phone/Fax

Practice location:
  • Phone: 606-476-8618
  • Fax: 606-328-5347
Mailing address:
  • Phone: 606-633-4871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DELENA P MILLER
Title or Position: PROVIDER INSURANCE CREDENTIALING
Credential:
Phone: 606-633-4823