Mountain Comprehensive Care Center, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Inez, KY
NPI 1285244244 · NPPES record last updated Aug 5, 2020
Key facts
- NPI
- 1285244244
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- MOUNTAIN COMPREHENSIVE CARE CENTER, INC.
- Practice address
- 428 E Main St
Inez, KY 41224-8931 - Phone
- (606) 788-1345
- NPI assigned
- Aug 5, 2020
- Organization subpart
- No
Authorized official
- Name
- Roxann Cordial
- Title
- Credentialing
- Phone
- (606) 886-8572
Other NPIs on the same Medicare enrollment 24
Other NPIs with the same Medicare PAC ID 24
Corporate family (same tax ID) 43
Practitioners 114
-
Lisa Paxton, LPCC
-
Marcella C Ramsey, LPCC
-
Melissa Aguilar, APRN
-
Jessica Campbell, APRN
-
Robert Darrell Castle II, LCADC/LPCC
-
Angela Damron, LCSW
-
Paul David Francis Jr., PMHNP
-
Kathy Jo Hamilton, APRN
-
Christi Hatfield, LCSW
-
Tyara Lynn Hughes, APRN
-
Kelly Kelley, LCSW
-
Amelia Kiser, APRN
-
Sasha Nunemaker, LPCC
-
Patricia Patton, APRN
-
Samantha Preece, LPCC
-
Andrea Mullins Quillen, APRN
-
Virginia Stambaugh, LPCC
-
Sheila Adkins, NP
-
Brooke Leemae Bays, APRN
-
Imani Blunt, LCSW
-
Kyndra Boone, PMHNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D2190628 | Mountain Comprehensive Care Center - | Certificate of waiver | Aug 17, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KY
Federally qualified health center certification: CCN B01002
- Legal name
- MOUNTAIN COMPREHENSIVE CARE CENTER INC
- Doing business as
- HOMEPLACE CLINIC INEZ
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Dec 11, 2020
- Last certification
- Dec 11, 2020
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 17, 1966 in KY
- Enrollment address
- 428 E Main St
Inez, KY 41224-8931
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Jim Vanover |
Corporate Director |
Jan 1, 2016 | |
| Sara Daniels |
Corporate Director |
Jan 1, 2014 | |
| Ancil W Lewis |
Corporate Director |
Jan 1, 2017 | |
| Lynette Schindler |
Corporate Director |
Jan 1, 2017 | |
| Jackie Tackett |
Corporate Director |
Jan 1, 2017 | |
| Durward E Hale |
Corporate Director |
Jan 1, 2017 | |
| Charles Branham |
Corporate Director |
Jan 1, 2019 | |
| Paula Thompson |
Corporate Director |
Jan 1, 2014 | |
| Teresa Petot |
Corporate Director |
Jan 1, 2017 | |
| Shirley Ratcliff |
Corporate Director |
Jan 1, 2015 | |
| Amanda Looney |
W-2 Managing Employee |
Dec 6, 2025 | |
| Promod Bishnoi |
Corporate Officer |
Jul 31, 2008 | |
| Corporate Director |
Jul 31, 2008 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040416000380 | KY | Part B Supplier - Clinic/Group Practice | 5294720553 |
Receives reassigned benefits from 237 practitioners 24 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Paintsville, KY; Pikeville, KY; Prestonsburg, KY; Salyersville, KY; Winchester, KY; Martin, KY; Ashland, KY; Belfry, KY… |
| O20201217001422 | KY | Part a Provider - Federally Qualified Health Center (FQHC) | 5294720553 | Practice locations: Inez, KY |
National Provider Directory
- Tax ID family
- Mountain Comprehensive Ca
Locations
130 Town Hill Rd
Louisa, KY 41230
1110 S Mayo Trl
#A
Paintsville, KY 41240
Phone (606) 788-1345
373 N Central Ave
Prestonsburg, KY 41653
123 N Main St
Winchester, KY 40391
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
428 E Main St
Inez, KY 41224-8931
Mailing address
104 S Front Ave
Prestonsburg, KY 41653-1614
Phone (606) 886-8572
Other names
- Homeplace Clinic Inez
Other providers in Inez, KY
- Patricia Faye McCoy
- Stacye Elizabeth McQueen
- Megan Mellert
- Bethany Mills
- Johnny Mills
- Mountain Comprehensive Care Center, Inc.
- Sharon N Neeley
- Net Care Inc
- Loretta Kay Nichols
- Lauren Niece
All providers in Inez, KY · Federally Qualified Health Center (FQHC) in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 5, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.