NPIMap

Organization Active NPI

North Fork Valley Community Health Board, Inc.

Doing business as UK North Fork Valley Community Health Center

  • Family Medicine Physician
  • Hazard, KY
National Provider Identifier
1164594511
Registry record updated Jan 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
NORTH FORK VALLEY COMMUNITY HEALTH BOARD, INC.
Doing business as
UK North Fork Valley Community Health Center
Practice address
750 Morton Blvd
Hazard, KY 41701-9469
Phone
(606) 439-1559
NPI assigned
Nov 14, 2006
Last updated
Jan 13, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2016

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

Authorized official

Name
Dr. Joe Eagle Kingery, D.O.
Title
Ceo
Phone
(606) 439-1559

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Adolescent Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0000X
Adult Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0505X
Geriatric Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QG0300X
Sports Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QS0010X

Addresses

Primary practice location

750 Morton Blvd
Hazard, KY 41701-9469

Mailing address

750 Morton Blvd
Hazard, KY 41701-9469
Phone (606) 439-1559

Other names 1

  • UK North Fork Valley Community Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061219000573 KY Part A Provider - Federally Qualified Health Center (FQHC) 5991704090 Practice locations: Hazard, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164594511. Details of each certification follow.

Federally qualified health center certification: CCN 181859

Legal name
NORTH FORK VALLEY COMMUNITY HEALTH BOARD, INC.
Doing business as
UK NORTH FORK VALLEY COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 7, 2007
Last certification
Feb 7, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 2, 2004 in KY
Enrollment address
750 Morton Blvd
Hazard, KY 41701-9469

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Ralph Hoskins Individual OtherBoard Member Dec 18, 2012 100%
Richard G. Crowe Individual OtherBoard Member, Chairman Sep 1, 2004 100%
Dell R. Niece Individual OtherBoard Member Sep 1, 2015 100%
Key C. Douthitt Individual OtherBoard Member, Medical Director, Dec 1, 2017 100%
Rudean Adams Individual OtherBoard Member May 1, 2009 100%
Linda S. Craft Individual OtherBoard Member Feb 1, 2017 100%
Karen a. Alfano Individual OtherBoard Member Jul 1, 2012 100%
Candace C Mendoza Individual OtherBoard Member Jun 1, 2015 100%
Larry Adams Individual OtherBoard Member, Officer Oct 1, 2011 100%
Steven L. Jones Individual OtherBoard Member Oct 1, 2015 100%
Shafter Haddix Individual OtherBoard Member Jan 1, 2017 100%
Larry C. Quillen Individual Operational/Managerial ControlCenter Administrator/Executive D Oct 1, 2016 100%
Robert C. Young Individual OtherBoard Member Jan 1, 2017 100%
Donald Porter Individual OtherBoard Member, Officer Jan 1, 2011 100%
Lora J. Hackney Individual OtherBoard Member Jun 24, 2014 100%

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452643200000",
    "number": "1164594511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 MORTON BLVD",
            "city": "HAZARD",
            "state": "KY",
            "postal_code": "417019469",
            "telephone_number": "606-439-1559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 MORTON BLVD",
            "city": "HAZARD",
            "state": "KY",
            "postal_code": "417019469",
            "telephone_number": "606-439-1559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH FORK VALLEY COMMUNITY HEALTH BOARD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2016-01-13",
        "status": "A",
        "authorized_official_last_name": "KINGERY",
        "authorized_official_first_name": "JOE",
        "authorized_official_middle_name": "EAGLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "606-439-1559",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207QA0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UK North Fork Valley Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hazard, KY

Sources for this page

Verify at the official NPI Registry.