NPIMap

Organization Active NPI

CCMH Corporation

  • Community/Retail Pharmacy
  • Carrollton, KY
National Provider Identifier
1760149413
Registry record updated Feb 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
CCMH CORPORATION
Practice address
309 11TH St Ste 1007
Carrollton, KY 41008-1435
Phone
(502) 732-4378
Fax
(502) 732-8214
NPI assigned
Nov 17, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2022

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

Authorized official

Name
Kimberly Haverly
Title
Ceo
Phone
(502) 732-3230

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

309 11TH St Ste 1007
Carrollton, KY 41008-1435

Mailing address

309 11TH St Ste 1007
Carrollton, KY 41008-1435
Phone (502) 732-4378

Other names 1

  • CCMH OUTPATIENT PHARMACY Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220616001578 KY DME Supplier - Pharmacy 2365540465 Practice locations: Carrollton, KY

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

309 11th St
Ste 1006
Carrollton, KY 41008
Phone (502) 732-3202

309 11th St
Ste 1007
Carrollton, KY 41008
Phone (502) 732-4378

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Carroll County Memorial HospitalCarrollton, KY, CCN 181310 Hospital Operational/Managerial Control (100%) Apr 8, 2007

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 25

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

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1637107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645747200000",
    "number": "1760149413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 11TH ST STE 1007",
            "city": "CARROLLTON",
            "state": "KY",
            "postal_code": "410081435",
            "telephone_number": "502-732-4378",
            "fax_number": "502-732-8214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 11TH ST STE 1007",
            "city": "CARROLLTON",
            "state": "KY",
            "postal_code": "410081435",
            "telephone_number": "502-732-4378",
            "fax_number": "502-732-8214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCMH CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-17",
        "last_updated": "2022-02-25",
        "certification_date": "2022-02-25",
        "status": "A",
        "authorized_official_last_name": "HAVERLY",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "502-732-3230"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CCMH OUTPATIENT PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carrollton, KY

Sources for this page

Verify at the official NPI Registry.