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General NPI Number Information
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NPI Number | 1447791512
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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 | 03/09/2017
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 1219 W MAIN ST
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City | WEST LIBERTY
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State | KY
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Zip | 41472-2161
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Country | US
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Telephone | 606-743-4808
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Fax | 606-743-4716
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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 | 606-743-4808
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Fax | 606-743-4716
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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
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Telephone | 606-464-0151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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 | KY
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