Healthcare Provider Details

I. General information

NPI: 1073310702
Provider Name (Legal Business Name): MOUNTAIN COMPREHENSIVE HEALTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 KY-15
HAZARD KY
41701-4185
US

IV. Provider business mailing address

PO BOX 40
WHITESBURG KY
41858-0040
US

V. Phone/Fax

Practice location:
  • Phone: 606-633-4871
  • Fax:
Mailing address:
  • Phone: 606-633-4871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

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