Healthcare Provider Details

I. General information

NPI: 1538736129
Provider Name (Legal Business Name): EAST KY HEALTH SERVICE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 HIGHWAY 899 # 849
HINDMAN KY
41822-8955
US

IV. Provider business mailing address

PO BOX 849
HINDMAN KY
41822-0849
US

V. Phone/Fax

Practice location:
  • Phone: 606-785-3164
  • Fax: 606-785-0107
Mailing address:
  • Phone: 606-785-3164
  • Fax: 606-785-0107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. BENNY RAY BAILEY
Title or Position: EXECUTIVE DIR / CEO
Credential: PH.D
Phone: 606-785-3164