Organization
MOUNTAIN COMPREHENSIVE HEALTH CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
L.M. (MIKE) CAUDILL (CHIEF EXECUTIVE OFFICER)
(606) 633-4823
Entity
Organization
Contact information
Practice address
105 ISOM PLZ, JEREMIAH, KY 41826-9088
(606) 633-2233
(606) 633-2223
Mailing address
PO BOX 40, WHITESBURG, KY 41858-0040
(606) 633-4823
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
09/12/2016
Last updated
10/07/2024
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