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
1	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician
3	261QF0400X	Federally Qualified Health Center (FQHC)
4	363LF0000X	Family Nurse Practitioner
5	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1821546573
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	:

Provider Business Practice Location Address
First Line	:	105 ISOM PLZ
Second Line	:
City	:	JEREMIAH
State	:	KY
Zip	:	41826-9088
Country	:	US
Telephone Number	:	606-633-2233
Fax Number	:	606-633-2223

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

Provider Enumeration Date	:	09/12/2016
Last Update Date	:	10/07/2024

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