Mountain Comprehensive Care Center, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Paintsville, KY
NPI 1548094808 · NPPES record last updated Aug 29, 2024
Key facts
- NPI
- 1548094808
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- MOUNTAIN COMPREHENSIVE CARE CENTER, INC.
- Practice address
- 341 Court St
Paintsville, KY 41240-1051 - Phone
- (606) 789-4675
- NPI assigned
- Aug 29, 2024
- Organization subpart
- No
Authorized official
- Name
- Roxann Cordial
- Title
- Credentialing Manager
- Phone
- (606) 886-8572
Other NPIs on the same Medicare enrollment 24
Other NPIs with the same Medicare PAC ID 24
Practitioners 89
-
Sheila Adkins, NP
-
Melissa Aguilar, APRN
-
Brooke Leemae Bays, APRN
-
Imani Blunt, LCSW
-
Kyndra Boone, PMHNP
-
Kristin J Bowman, APRN
-
Karen Bradley, APRN
-
Jessica Lee Branham, D.O.
-
Jessica Briggs, LCSW
-
James Adam Butler, LPCC
-
Angela M Campbell, APRN
-
Deonna Campbell, APRN-PMHNP
-
Jessica Campbell, APRN
-
Sarah J Campbell, APRN
-
Carla J Castle, APRN-FNP
-
Robert Darrell Castle II, LCADC/LPCC
-
Sarah Coleman, LCSW
-
Keisha Combs, LCSW
-
Carolyn Compton, APRN
-
Martha E. Copley Coleman, LCSW
-
Ashley Cornett, APRN, PMHNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KY
Federally qualified health center certification: CCN B01154
- Legal name
- MOUNTAIN COMPREHENSIVE CARE CENTER INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jan 9, 2025
- Last certification
- Jan 9, 2025
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 341 Court St
Paintsville, KY 41240-1051
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Jim Vanover |
Corporate Director |
Jan 1, 2016 | |
| Sara Daniels |
Corporate Officer |
Jan 1, 2014 | |
| Ancil W Lewis |
Corporate Director |
Jan 1, 2017 | |
| Lynette Schindler |
Corporate Director |
Jan 1, 2017 | |
| Jackie Tackett |
Corporate Director |
Jan 1, 2016 | |
| 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 Officer |
Jan 1, 2015 | |
| Amanda Looney |
W-2 Managing Employee |
Dec 6, 2025 | |
| Promod Bishnoi |
Corporate Officer |
Jul 31, 2008 | |
| Corporate Director |
Jul 31, 2008 | ||
| Other | 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… |
| O20250109003603 | KY | Part a Provider - Federally Qualified Health Center (FQHC) | 5294720553 | Practice locations: Paintsville, KY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
341 Court St
Paintsville, KY 41240-1051
Mailing address
104 S Front Ave
Prestonsburg, KY 41653-1614
Phone (606) 886-8572
Other names
- Homeplace Eye Care
Other providers in Paintsville, KY
- Molecular Imaging of Eastern Kentucky, LLC
- Kelli Jo Montgomery
- Jennifer Moore
- Mountain Apothecary
- Mountain Comprehensive Care Center, Inc.
- Mountain Comprehensive Care Center, Inc.
- Mountain Comprehensive Care Center, Inc.
- Lynn Dorton Mullins
- Nabil Basha, M.D., P.S.C.
- New Age Vitality Clinic LLC
All providers in Paintsville, 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 29, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.