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

General Provider Information

NPI Number	:	1215818414
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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 E MAIN ST
Second Line	:
City	:	ELKHORN CITY
State	:	KY
Zip	:	41522-9043
Country	:	US
Telephone Number	:	606-414-2280
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	DELENA P MILLER
Credential	:
Telephone Number	:	606-633-4823

Provider Enumeration Date	:	09/12/2025
Last Update Date	:	09/12/2025

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