Healthcare Provider Details

I. General information

NPI: 1114705944
Provider Name (Legal Business Name): JUNIPER HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 KY 715
ROGERS KY
41365-8335
US

IV. Provider business mailing address

PO BOX 690
BEATTYVILLE KY
41311-0690
US

V. Phone/Fax

Practice location:
  • Phone: 606-464-0151
  • Fax: 606-464-0152
Mailing address:
  • Phone: 606-464-0151
  • Fax: 606-464-0152

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: DERRICK J HAMILTON
Title or Position: CEO
Credential: DO
Phone: 606-666-9950