Grace Community Health Center Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Corbin, KY
NPI 1508308560 · NPPES record last updated Jun 28, 2024
Key facts
- NPI
- 1508308560
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 700188 (KY)
- Legal business name
- GRACE COMMUNITY HEALTH CENTER INC
- Practice address
- 1419 Cumberland Falls Highway
Corbin, KY 40701-2722 - Phone
- (606) 528-4481
- Fax
- (606) 528-6531
- NPI assigned
- Nov 8, 2016
- Organization subpart
- Yes
- Parent organization (as reported)
- GRACE COMMUNITY HEALTH CENTER INC
Authorized official
- Name
- Michael W. Stanley
- Title
- C.E.O.
- Phone
- (606) 526-9005
Other NPIs on the same Medicare enrollment 5
Practitioners 13
-
Morgan Whitney Birch, D.O.
-
Joseph Paul Campbell, LCSW
-
Kassidy Michaela Creech, LCSW
-
William R Durham, MD
-
William F. Hast, D.M.D.
-
Indira Moodumane, MD
-
Edith L Roberts, APRN
-
Erin B Wells, APRN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081211000571 | KY | Part B Supplier - Clinic/Group Practice | 3870654064 |
Receives reassigned benefits from 90 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Pineville, KY; Williamsburg, KY; Manchester, KY; London, KY; Hyden, KY; Corbin, KY; Booneville, KY |
National Provider Directory
- Part of
- Grace Health Pharmacy-Manchester
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist |
103T00000X | |||
| Clinical Psychologist |
103TC0700X | |||
| Internal Medicine Physician |
207R00000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | 700188 | KY | Yes |
| Primary Care Clinic/Center | 261QP2300X | 700188 | KY | |
| Nurse Practitioner |
363L00000X | |||
| Family Nurse Practitioner |
363LF0000X |
Addresses
Primary practice location
1419 Cumberland Falls Highway
Corbin, KY 40701-2722
Mailing address
1019 Cumberland Falls Hwy
Suite B201
Corbin, KY 40701-2735
Phone (606) 526-9005
Other names
- Falls Hwy Clinic
Other providers in Corbin, KY
- Grace Community Health Center Inc
- Grace Community Health Center Inc
- Grace Community Health Center Inc
- Grace Community Health Center Inc
- Grace Community Health Center Inc
- Grace Community Health Center Inc
- Grace Community Health Center Inc
- Grace Community Health Center Inc
- Grace Community Health Center Inc
- Grace Community Health Center Inc
All providers in Corbin, 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 Jun 28, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.