NPIMap

Organization Active NPI

Mountain Comprehensive Health Corporation

Doing business as Middlesboro Campus Clinic

  • Primary Care Clinic/Center
  • Middlesboro, KY
National Provider Identifier
1063913788
Registry record updated Apr 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
MOUNTAIN COMPREHENSIVE HEALTH CORPORATION
Doing business as
Middlesboro Campus Clinic
Mobile Health Clinic
Practice address
1530 US Highway 25 E
Middlesboro, KY 40965-1861
Phone
(606) 654-9450
Fax
(606) 302-4240
NPI assigned
Feb 27, 2018
Last updated
Apr 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2025

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

Authorized official

Name
Delena P Miller
Title
Credentialing
Phone
(606) 633-4823

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 700017 KY
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

1530 US Highway 25 E
Middlesboro, KY 40965-1861

Mailing address

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

Other practice location 1

100 College Rd Ste 131-132
Middlesboro, KY 40965-8303
Phone (606) 654-9450

Other practice location 2

1540 US Highway 25 E
Middlesboro, KY 40965-1861
Phone (606) 654-9450

Other names 2

  • Middlesboro Campus Clinic Doing business as
  • Mobile Health Clinic Doing business as

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…
O20180315001335 KY Part A Provider - Federally Qualified Health Center (FQHC) 7618875873 Practice locations: Middlesboro, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063913788. Details of each certification follow.

Federally qualified health center certification: CCN 181061

Legal name
MOUNTAIN COMPREHENSIVE HEALTH CORPORATION
Doing business as
MIDDLESBORO CAMPUS CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 5, 2018
Last certification
Mar 5, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 14, 1972 in KY
Enrollment address
1530 US Highway 25 E
Middlesboro, KY 40965-1861

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
Tax ID family
MTN Comprehensive HLTH35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

Organizations that report the same tax identification number in the National Provider Directory.

View all 34

Locations

100 College Rd
Ste 131132
Middlesboro, KY 40965
Phone (606) 654-9450

1540 US Highway 25 E
Middlesboro, KY 40965
Phone (606) 654-9450

Ownership & related parties

All disclosed owners & managing parties 17

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 Aug 1, 2012
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, 2019
Teresa Hunter Individual Corporate DirectorBoard Member Jan 1, 2025
Mary Ann Sparks Individual Corporate DirectorBoard Member Jan 1, 2020
Paul Pratt Individual Corporate DirectorBoard Chairman Jan 1, 2016
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 DirectorBoard Vice-Chairman Jan 1, 2024

All facility ownership & control disclosures 4

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
Letcher County Alternative Education School Based ClinicWhitesburg, KY, CCN 181892 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 4

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

Practitioners & affiliated clinicians

Practitioners 7

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": "1519689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743552000000",
    "number": "1063913788",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 US HIGHWAY 25 E",
            "city": "MIDDLESBORO",
            "state": "KY",
            "postal_code": "409651861",
            "telephone_number": "606-654-9450",
            "fax_number": "606-302-4240"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 College Rd Ste 131-132",
            "address_purpose": "LOCATION",
            "city": "Middlesboro",
            "state": "KY",
            "postal_code": "409658303",
            "country_code": "US",
            "telephone_number": "606-654-9450",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1540 US Highway 25 E",
            "address_purpose": "LOCATION",
            "city": "Middlesboro",
            "state": "KY",
            "postal_code": "409651861",
            "country_code": "US",
            "telephone_number": "606-654-9450",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MOUNTAIN COMPREHENSIVE HEALTH CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-27",
        "last_updated": "2025-04-02",
        "certification_date": "2025-04-02",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "DELENA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "606-633-4823"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "KY",
            "license": "700017",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Middlesboro Campus Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mobile Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Middlesboro, KY

Sources for this page

Verify at the official NPI Registry.