MEDICARE: JUNIPER HEALTH INC

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	122300000X	Dentist
2	261QD0000X	Dental Clinic/Center
3	261QF0400X	Federally Qualified Health Center (FQHC)	700132	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	9521	OTHER	KY	MEDICARE PART B

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	181848	OTHER	KY	MEDCIARE FQHC PTAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407818628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUNIPER HEALTH INC

Provider Business Mailing Address
First Line	:	PO BOX 690
Second Line	:
City	:	BEATTYVILLE
State	:	KY
Zip	:	41311-0690
Country	:	US
Telephone Number	:	606-464-0151
Fax Number	:	606-464-1052

Provider Business Practice Location Address
First Line	:	1025 GRAND AVENUE
Second Line	:
City	:	BEATTYVILLE
State	:	KY
Zip	:	41311-9249
Country	:	US
Telephone Number	:	606-464-2401
Fax Number	:	606-464-3290

Authorized Official
Title or Position	:	CEO
Name	:	DERRICK J HAMILTON
Credential	:	DO, CEO, CMO
Telephone Number	:	606-666-9950

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	05/12/2025

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Directions to “JUNIPER HEALTH INC ” Practice Location

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