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General NPI Number Information
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NPI Number | 1669588505
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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 | 08/22/2006
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Last Update Date | 03/27/2020
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Provider Practice Location Address
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Address Line | 141 MAIN STREET
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City | BEATTYVILLE
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State | KY
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Zip | 41311
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Country | US
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Telephone | 606-464-0151
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Fax | 606-464-0152
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Provider Business Mailing Address
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Address Line | 141 MAIN STREET P.O. BOX 690
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City | BEATTYVILLE
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State | KY
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Zip | 41311
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Country | US
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Telephone | 606-464-0151
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Fax | 606-464-0152
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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
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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 | 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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