NPIMap

Organization Active NPI

Mountain Comprehensive Health Corporation

  • Primary Care Clinic/Center
  • Whitesburg, KY
National Provider Identifier
1003164203
Registry record updated Jun 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
MOUNTAIN COMPREHENSIVE HEALTH CORPORATION
Practice address
185 Circle Dr Ste a
Whitesburg, KY 41858-7662
Phone
(606) 633-4823
Fax
(606) 633-1874
NPI assigned
Aug 17, 2012
Last updated
Jun 29, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
L.M. (Mike) Caudill
Title
Ceo
Phone
(606) 633-4823

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU
Primary Care Clinic/Center 261QP2300X NU Primary
Physician Assistant 363A00000X NU
Primary Care Nurse Practitioner 363LP2300X NU
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

185 Circle Dr Ste a
Whitesburg, KY 41858-7662

Mailing address

PO Box 40
Whitesburg, KY 41858-0040
Phone (606) 633-4823

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031224000024 KY Part B Supplier - Clinic/Group Practice 7618875873 Receives reassigned benefits from 92 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jeremiah, KY; Whitesburg, KY; Pineville, KY; Middlesboro, KY; Hindman, KY; Harlan, KY; Elkhorn City, KY; Cumberland, KY…
O20121228000086 KY Part A Provider - Federally Qualified Health Center (FQHC) 7618875873 Practice locations: Whitesburg, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003164203. Details of each certification follow.

Federally qualified health center certification: CCN 181892

Legal name
MOUNTAIN COMPREHENSIVE HEALTH CORPORATION
Doing business as
LETCHER COUNTY ALTERNATIVE EDUCATION SCHOOL BASED CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 28, 2012
Last certification
Dec 28, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 14, 1972 in KY
Enrollment address
185 Circle Dr
Ste a
Whitesburg, KY 41858-7662

Other NPIs with the same Medicare PAC ID 24

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 24

Other NPIs on the same Medicare enrollment 13

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 13

National Provider Directory

National Provider Directory

Locations

185 Circle Dr
#A
Whitesburg, KY 41858
Phone (606) 633-6062

Ownership & related parties

All disclosed owners & managing parties 18

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Sherry Childers Individual Corporate DirectorBoard Treasurer Jan 1, 2024
Steve Peake Individual Corporate DirectorBoard Member Jul 20, 2022
William Parks Individual Corporate DirectorBoard Member Jan 1, 2018
Jerry Hall Individual Corporate DirectorBoard Member Jan 1, 2022
Mike Caudill Individual Corporate OfficerChief Executive Officer Jul 1, 2005
David Adams Individual Corporate DirectorBoard Member Jan 1, 2024
Teresa Dotson Individual Corporate OfficerChief Operating Officer Sep 8, 2025
W-2 Managing EmployeeChief Operating Officer Sep 8, 2025
Charles Colwell Individual Corporate DirectorBoard Member Jan 1, 2025
Gwen Johnson Individual Corporate DirectorBoard Member Jan 1, 2025
Jackie Colwell Individual Corporate DirectorBoard Member Jan 1, 2018
Teresa Hunter Individual Corporate DirectorBoard Member Jan 1, 2025
Mountain Comprehensive Health Corporation Organization, Whitesburg, KY Non-profit Operational/Managerial Control Aug 1, 2012
Mary Ann Sparks Individual Corporate DirectorBoard Member Jan 1, 2020
Paul Pratt Individual Corporate DirectorChairman of the Board Jan 1, 2023
Nanette Banks Individual Corporate DirectorBoard Secretary Jan 1, 2023
Robert Musick Individual Corporate DirectorBoard Member Sep 17, 2024
Carlana G. Mullins Individual Corporate DirectorBoard Member Jan 1, 2013
Kathy Hall Individual Corporate DirectorVice-Chairman of the Board Jan 1, 2024

Owners & managing parties with NPI records 24

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 24

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Mountain Comprehensive Health CorporationWhitesburg, KY, CCN 181893 Federally qualified health center Operational/Managerial Control Aug 1, 2012
Mountain Comprehensive Health CorporationLetcher, KY, CCN 181891 Federally qualified health center Operational/Managerial Control Aug 1, 2012
Mountain Comprehensive Health CorporationWhitesburg, KY, CCN 181894 Federally qualified health center Operational/Managerial Control Aug 1, 2012

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1345161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624924800000",
    "number": "1003164203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40",
            "city": "WHITESBURG",
            "state": "KY",
            "postal_code": "418580040",
            "telephone_number": "606-633-4823",
            "fax_number": "606-633-1874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 CIRCLE DR STE A",
            "city": "WHITESBURG",
            "state": "KY",
            "postal_code": "418587662",
            "telephone_number": "606-633-4823",
            "fax_number": "606-633-1874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN COMPREHENSIVE HEALTH CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-17",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A",
        "authorized_official_last_name": "CAUDILL",
        "authorized_official_first_name": "L.M. (MIKE)",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "606-633-4823"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Whitesburg, KY

Sources for this page

Verify at the official NPI Registry.