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General NPI Number Information
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NPI Number | 1508277831
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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 | 05/08/2014
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Last Update Date | 05/08/2014
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Provider Practice Location Address
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Address Line | 9165 S KY HWY 15 SUITE A
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City | HAPPY
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State | KY
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Zip | 41746
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Country | US
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Telephone | 606-476-2518
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Fax |
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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 |
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Authorized Official
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Title or Position | CEO
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Name | 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 | 363A00000X
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Taxonomy Name | Physician Assistant
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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