NPIMap

Organization Active NPI

Mountain Comprehensive Health Corporation

Doing business as Pound Medical Clinic

  • Federally Qualified Health Center (FQHC)
  • Pound, VA
National Provider Identifier
1366201246
Registry record updated Apr 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MOUNTAIN COMPREHENSIVE HEALTH CORPORATION
Doing business as
Pound Medical Clinic
Practice address
11313 Highland Ave
Pound, VA 24279-4145
Phone
(276) 796-8100
NPI assigned
Mar 14, 2024
Last updated
Apr 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2024

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 Primary
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 1

  • Pound Medical Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366201246. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Mar 14, 1972 in KY
Enrollment address
11313 Highland Ave
Pound, VA 24279-4145

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D2296875MCHC Pound Medical Clinic11313 Highland Avenue, Pound, VA 24279Certificate of waiverJan 7, 2028

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

Ownership & related parties

All disclosed owners & managing parties 16

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 Member Jan 1, 2024
Steve Peake Individual Corporate DirectorBoard Member Jul 20, 2022
Stephen Adams Individual Corporate DirectorBoard Treasurer Jan 1, 2018
William Parks Individual Corporate DirectorBoard Member Jan 1, 2018
Cathie Day Individual Corporate DirectorBoard Secretary Jan 1, 2018
Jerry Hall Individual Corporate DirectorBoard Member Jan 1, 2022
Mike Caudill Individual Corporate OfficerChief Executive Officer Aug 1, 2012
Phyllis Ingram Individual Corporate DirectorBoard Vice-Chairman Jan 1, 2022
Phillip Hampton Individual Corporate OfficerChief Operating Officer Aug 1, 2012
W-2 Managing EmployeeChief Operating Officer Aug 1, 2012
David Adams Individual Corporate DirectorBoard Member Jan 1, 2024
Jackie Colwell Individual Corporate DirectorBoard Member Jan 1, 2019
Mary Ann Sparks Individual Corporate DirectorBoard Member Jan 1, 2020
Paul Pratt Individual Corporate DirectorBoard Chairman Jan 1, 2023
Nanette Banks Individual Corporate DirectorBoard Member Jan 1, 2023
Carlana G. Mullins Individual Corporate DirectorBoard Member Jan 1, 2020
Kathy Hall Individual Corporate DirectorBoard Member 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 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": "1710374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713139200000",
    "number": "1366201246",
    "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": "11313 HIGHLAND AVE",
            "city": "POUND",
            "state": "VA",
            "postal_code": "242794145",
            "telephone_number": "276-796-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN COMPREHENSIVE HEALTH CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-14",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "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": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pound Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pound, VA

Sources for this page

Verify at the official NPI Registry.