NPIMap

Organization Active NPI

Morehead Pediatrics

  • Rural Health Clinic/Center
  • Morehead, KY
National Provider Identifier
1710688809
Registry record updated Jun 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MOREHEAD PEDIATRICS
Practice address
130 Newtowne SQ
Morehead, KY 40351-2406
Phone
(606) 740-0986
Fax
(606) 780-9096
NPI assigned
Mar 15, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2024

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

Authorized official

Name
Dennis Fouch
Title
Coo
Phone
(859) 498-5243

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

130 Newtowne SQ
Morehead, KY 40351-2406

Mailing address

130 Newtowne SQ
Morehead, KY 40351-2406
Phone (606) 740-0986

Other identifiers 1

IdentifierTypeStateIssuer
7100979520MedicaidKY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230828000693 KY Part A Provider - Rural Health Clinic 1456714260 Practice locations: Morehead, KY

Rural health clinic certification: CCN B03956

Legal name
MOREHEAD PEDIATRICS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 16, 2024
Last certification
Apr 16, 2024
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Jan 26, 2022 in KY
Enrollment address
130 Newtowne SQ
Morehead, KY 40351-2406

National Provider Directory

National Provider Directory
Tax ID family
Morehead Pediatrics2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

130 Newtowne Sq
Morehead, KY 40351
Phone (606) 740-0986

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Brandy B Fouch Individual 5% Or Greater Direct Ownership InterestPresident Jan 26, 2022 100%
Corporate DirectorPresident Jan 26, 2022
Operational/Managerial Control Jan 26, 2022
Dennis Fouch Individual Corporate DirectorCoo Apr 1, 2023
W-2 Managing EmployeeCoo Apr 1, 2023

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1678838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718236800000",
    "number": "1710688809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 NEWTOWNE SQ",
            "city": "MOREHEAD",
            "state": "KY",
            "postal_code": "403512406",
            "telephone_number": "606-740-0986",
            "fax_number": "606-780-9096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 NEWTOWNE SQ",
            "city": "MOREHEAD",
            "state": "KY",
            "postal_code": "403512406",
            "telephone_number": "606-740-0986",
            "fax_number": "606-780-9096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOREHEAD PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-15",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A",
        "authorized_official_last_name": "FOUCH",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "859-498-5243"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100979520",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Morehead, KY

Sources for this page

Verify at the official NPI Registry.