MEDICARE: MOUNTAIN COMPREHENSIVE HEALTH CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)
2	261QP2300X	Primary Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043257827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN COMPREHENSIVE HEALTH CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 40
Second Line	:
City	:	WHITESBURG
State	:	KY
Zip	:	41858-0040
Country	:	US
Telephone Number	:	606-633-4823
Fax Number	:	606-633-1874

Provider Business Practice Location Address
First Line	:	826 KY 11 N
Second Line	:
City	:	BOONEVILLE
State	:	KY
Zip	:	41314-9155
Country	:	US
Telephone Number	:	606-593-6395
Fax Number	:	606-593-5916

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. L.M. (MIKE) CAUDILL
Credential	:
Telephone Number	:	606-633-4823

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	10/07/2024

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Directions to “MOUNTAIN COMPREHENSIVE HEALTH CORPORATION ” Practice Location

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