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General NPI Number Information
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NPI Number | 1407818628
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Entity Type | Organization
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Legal Business Name | JUNIPER HEALTH INC
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 1025 GRAND AVENUE
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City | BEATTYVILLE
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State | KY
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Zip | 41311-9249
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Country | US
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Telephone | 606-464-2401
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Fax | 606-464-3290
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Provider Business Mailing Address
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Address Line | PO BOX 690
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City | BEATTYVILLE
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State | KY
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Zip | 41311-0690
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Country | US
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Telephone | 606-464-0151
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Fax | 606-464-1052
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Authorized Official
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Title or Position | CEO
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Name | DERRICK J HAMILTON
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Credential | DO, CEO, CMO
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Telephone | 606-666-9950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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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 | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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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 | 700132
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License Number State | KY
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