Mountain Comprehensive Health Corporation
Organization Active NPI Federally Qualified Health Center (FQHC) · Pound, VA
NPI 1366201246 · NPPES record last updated Apr 15, 2024
Key facts
- NPI
- 1366201246
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- MOUNTAIN COMPREHENSIVE HEALTH CORPORATION
- Practice address
- 11313 Highland Ave
Pound, VA 24279-4145 - Phone
- (276) 796-8100
- NPI assigned
- Mar 14, 2024
- Organization subpart
- No
Authorized official
- Name
- Delena P Miller
- Title
- Credentialing
- Phone
- (606) 633-4823
Owned or controlled facilities with NPI records 4
Other NPIs with the same Medicare PAC ID 24
Corporate family (same tax ID) 34
Practitioners 83
-
Mary Beth Hamilton, APRN
-
Kyla G. Stanley, APRN
-
Devin N Whitt, APRN
-
Paul G Vaccaro Jr., M.D.
-
Lindsey Adams, APRN-CNP
-
Mahmood Alam, MD
-
Karen Lynn Baker, LPCC-S
-
Nathan W Baker, MD
-
Shana Rae Banks, APRN
-
David Shane Barker, O.D.
-
Lisa Gail Bates, ARNP
-
Brittany Bobrowski, D.O.
-
Audra Boggs, M.ED, LPCC
-
Marye Margaret Campbell Boggs, MD,MPH
-
Matthew Troy Breeding, D.O.
-
Van S Breeding, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 49D2296875 | MCHC Pound Medical Clinic | Certificate of waiver | Jan 7, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VA
Federally qualified health center certification: CCN 491027
- Legal name
- MOUNTAIN COMPREHENSIVE HEALTH CORPORATION
- Doing business as
- POUND MEDICAL CLINIC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jul 24, 2024
- Last certification
- Jul 24, 2024
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 14, 1972 in KY
- Enrollment address
- 11313 Highland Ave
Pound, VA 24279-4145
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Sherry Childers |
Corporate Director |
Jan 1, 2024 | |
| Steve Peake |
Corporate Director |
Jul 20, 2022 | |
| Stephen Adams |
Corporate Director |
Jan 1, 2018 | |
| William Parks |
Corporate Director |
Jan 1, 2018 | |
| Cathie Day |
Corporate Director |
Jan 1, 2018 | |
| Jerry Hall |
Corporate Director |
Jan 1, 2022 | |
| Mike Caudill |
Corporate Officer |
Aug 1, 2012 | |
| Phyllis Ingram |
Corporate Director |
Jan 1, 2022 | |
| Phillip Hampton |
Corporate Officer |
Aug 1, 2012 | |
| W-2 Managing Employee |
Aug 1, 2012 | ||
| David Adams |
Corporate Director |
Jan 1, 2024 | |
| Jackie Colwell |
Corporate Director |
Jan 1, 2019 | |
| Mary Ann Sparks |
Corporate Director |
Jan 1, 2020 | |
| Paul Pratt |
Corporate Director |
Jan 1, 2023 | |
| Nanette Banks |
Corporate Director |
Jan 1, 2023 | |
| Carlana G. Mullins |
Corporate Director |
Jan 1, 2020 | |
| Kathy Hall |
Corporate Director |
Jan 1, 2024 |
All facility ownership & control disclosures 4
| Facility | Type | Role | Since |
|---|---|---|---|
| Mountain Comprehensive Health Corporation |
Federally qualified health center | Operational/Managerial Control | Aug 1, 2012 |
| Letcher County Alternative Education School Based Clinic |
Federally qualified health center | Operational/Managerial Control | Aug 1, 2012 |
| Mountain Comprehensive Health Corporation |
Federally qualified health center | Operational/Managerial Control | Aug 1, 2012 |
| Mountain Comprehensive Health Corporation |
Federally qualified health center | Operational/Managerial Control | Aug 1, 2012 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240517000820 | VA | Part B Supplier - Clinic/Group Practice | 7618875873 |
Receives reassigned benefits from 4 practitioners Practice locations: Pound, VA |
| O20240606004133 | VA | Part a Provider - Federally Qualified Health Center (FQHC) | 7618875873 | Practice locations: Pound, VA |
National Provider Directory
- Tax ID family
- MTN Comp Health Corp
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes | ||
| Primary Care Clinic/Center | 261QP2300X |
Addresses
Primary practice location
11313 Highland Ave
Pound, VA 24279-4145
Mailing address
PO Box 40
Whitesburg, KY 41858-0040
Phone (606) 633-4823
Other names
- Pound Medical Clinic
Other providers in Pound, VA
- Michael Brian Deel
- Experienced Care Clinic Inc.
- Family Preservation Services, Inc
- Scotty R Matney
- Melissa Lea Morton-Fishman
- Mountain Comprehensive Health Corporation
- Gregory Brian Mullins
- Tiffany Beth Mullins
- Nantz Apothecary
- Rachel'S Haven, Inc.
All providers in Pound, VA · Federally Qualified Health Center (FQHC) in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 15, 2024. 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.