Healthcare Provider Details

I. General information

NPI: 1033166350
Provider Name (Legal Business Name): MOUNTAIN COMPREHENSIVE HEALTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 MEDICAL PLAZA LN
WHITESBURG KY
41858-7425
US

IV. Provider business mailing address

PO BOX 70
WHITESBURG KY
41858-0070
US

V. Phone/Fax

Practice location:
  • Phone: 606-633-4871
  • Fax: 606-633-1874
Mailing address:
  • Phone: 606-633-4823
  • Fax: 606-633-1874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS L.M. (MIKE) CAUDILL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 606-633-4823