Healthcare Provider Details

I. General information

NPI: 1396517322
Provider Name (Legal Business Name): BIG SANDY HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 MT RAIDER DR
HI HAT KY
41636-6230
US

IV. Provider business mailing address

1709 KY ROUTE 321
PRESTONSBURG KY
41653-9097
US

V. Phone/Fax

Practice location:
  • Phone: 606-263-6500
  • Fax: 866-927-9488
Mailing address:
  • Phone: 606-886-8546
  • Fax: 606-886-8548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES HERALD
Title or Position: CEO
Credential:
Phone: 606-886-8546