NPIMap

Organization Active NPI

Mountain Comprehensive Health Corporation

  • Primary Care Clinic/Center
  • Whitesburg, KY
National Provider Identifier
1649528845
Registry record updated Oct 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
MOUNTAIN COMPREHENSIVE HEALTH CORPORATION
Practice address
435 Cougar Dr
Whitesburg, KY 41858-7009
Phone
(606) 633-4823
Fax
(606) 633-1874
NPI assigned
Aug 17, 2012
Last updated
Oct 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
L.M. (Mike) Caudill
Title
Ceo
Phone
(606) 633-4823

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Primary Care Clinic/Center 261QP2300X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X

Addresses

Primary practice location

435 Cougar Dr
Whitesburg, KY 41858-7009

Mailing address

PO Box 40
Whitesburg, KY 41858-0040
Phone (606) 633-4823

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121229000011 KY Part A Provider - Federally Qualified Health Center (FQHC) 7618875873 Practice locations: Whitesburg, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649528845. Details of each certification follow.

Federally qualified health center certification: CCN 181898

Legal name
MOUNTAIN COMPREHENSIVE HEALTH CORPORATION
Doing business as
LETCHER COUNTY CENTRAL HIGH SCHOOL BASED CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 29, 2012
Last certification
Dec 29, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 14, 1972 in KY
Enrollment address
435 Cougar Dr
Whitesburg, KY 41858-7009

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

National Provider Directory

National Provider Directory
Tax ID family
Mountain Comp Health35 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 17

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 Treasurer Jan 1, 2024
Amanda Maggard Individual Corporate DirectorBoard Member Jan 1, 2026
Steve Peake Individual Corporate DirectorBoard Member Jul 20, 2022
Jerry Hall Individual Corporate DirectorBoard Member Jan 1, 2022
Mike Caudill Individual Corporate OfficerChief Executive Officer Jul 1, 2005
Matilda Parks Individual Corporate DirectorBoard Member Jan 1, 2026
Gary W Turner Individual Corporate DirectorBoard Member Jan 1, 2026
David Adams Individual Corporate DirectorBoard Member Jan 1, 2016
Teresa Dotson Individual Corporate OfficerChief Operating Officer Sep 8, 2025
W-2 Managing EmployeeChief Operating Officer Sep 8, 2025
Charles Colwell Individual Corporate DirectorBoard Member Jan 1, 2025
Gwen Johnson Individual Corporate DirectorBoard Member Jan 1, 2025
Teresa Hunter Individual Corporate DirectorBoard Member Jan 1, 2025
Paul Pratt Individual Corporate DirectorChairman of the Board Jan 1, 2016
Nanette Banks Individual Corporate DirectorBoard Secretary Jan 1, 2023
Robert Musick Individual Corporate DirectorBoard Member Sep 17, 2024
Carlana G. Mullins Individual Corporate DirectorBoard Member Jan 1, 2013
Kathy Hall Individual Corporate DirectorVice-Chairman of the Board Jan 1, 2024

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1345161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728259200000",
    "number": "1649528845",
    "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",
            "fax_number": "606-633-1874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 COUGAR DR",
            "city": "WHITESBURG",
            "state": "KY",
            "postal_code": "418587009",
            "telephone_number": "606-633-4823",
            "fax_number": "606-633-1874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN COMPREHENSIVE HEALTH CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-17",
        "last_updated": "2024-10-07",
        "certification_date": "2024-10-07",
        "status": "A",
        "authorized_official_last_name": "CAUDILL",
        "authorized_official_first_name": "L.M. (MIKE)",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "606-633-4823"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Whitesburg, KY

Sources for this page

Verify at the official NPI Registry.