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General NPI Number Information
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NPI Number | 1316991979
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Entity Type | Organization
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Legal Business Name | MOUNTAIN COMPREHENSIVE HEALTH CORPORATION
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 132 VILLAGE CENTER RD
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City | HARLAN
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State | KY
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Zip | 40831-1777
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Country | US
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Telephone | 606-573-7771
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Fax | 606-573-2809
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Provider Business Mailing Address
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Address Line | PO BOX 40
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City | WHITESBURG
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State | KY
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Zip | 41858-0040
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Country | US
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Telephone | 606-633-4823
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Fax | 606-633-1874
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. L.M. (MIKE) CAUDILL
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Credential |
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Telephone | 606-633-4823
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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