Mountain Comprehensive Health Corporation
Organization Active NPI Primary Care Clinic/Center · Jeremiah, KY
NPI 1821546573 · NPPES record last updated Oct 7, 2024
Key facts
- NPI
- 1821546573
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- MOUNTAIN COMPREHENSIVE HEALTH CORPORATION
- Practice address
- 105 Isom PLZ
Jeremiah, KY 41826-9088 - Phone
- (606) 633-2233
- Fax
- (606) 633-2223
- NPI assigned
- Sep 12, 2016
- Organization subpart
- No
Authorized official
- Name
- L.M. (Mike) Caudill
- Title
- Chief Executive Officer
- Phone
- (606) 633-4823
Owned or controlled facilities with NPI records 4
Other NPIs on the same Medicare enrollment 13
Other NPIs with the same Medicare PAC ID 24
Corporate family (same tax ID) 34
Practitioners 82
-
Lindsey Adams, APRN-CNP
-
Lora Kalynn Cook, APRN
-
Sabrina Sergent, APRN
-
Savanna Wynn, APRN
-
Mahmood Alam, MD
-
Karen Lynn Baker, LPCC-S
-
Nathan W Baker, MD
-
Shana Rae Banks, APRN
-
David Shane Barker, O.D.
-
Lisa Gail Bates, ARNP
-
Brittany Bobrowski, D.O.
-
Audra Boggs, M.ED, LPCC
-
Marye Margaret Campbell Boggs, MD,MPH
-
Matthew Troy Breeding, D.O.
-
Van S Breeding, MD
-
Megan R. Cole, APRN
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D2032974 | MCHC Isom Medical Clinic | Certificate of waiver | Nov 17, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KY
Federally qualified health center certification: CCN 181986
- Legal name
- MOUNTAIN COMPREHENSIVE HEALTH CORPORATION
- Doing business as
- ISOM MEDICAL CLINIC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Sep 28, 2016
- Last certification
- Sep 28, 2016
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 14, 1972 in KY
- Enrollment address
- 105 Isom PLZ
Jeremiah, KY 41826-9088
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| Sherry Childers |
Corporate Director |
Jan 1, 2024 | |
| Steve Peake |
Corporate Director |
Jul 20, 2022 | |
| William Parks |
Corporate Director |
Jan 1, 2018 | |
| Jerry Hall |
Corporate Director |
Jan 1, 2022 | |
| Mike Caudill |
Corporate Officer |
Jul 1, 2005 | |
| David Adams |
Corporate Director |
Jan 1, 2024 | |
| Teresa Dotson |
Corporate Officer |
Sep 8, 2025 | |
| W-2 Managing Employee |
Sep 8, 2025 | ||
| Charles Colwell |
Corporate Director |
Jan 1, 2025 | |
| Gwen Johnson |
Corporate Director |
Jan 1, 2025 | |
| Jackie Colwell |
Corporate Director |
Jan 1, 2019 | |
| Teresa Hunter |
Corporate Director |
Jan 1, 2025 | |
| Mary Ann Sparks |
Corporate Director |
Jan 1, 2020 | |
| Paul Pratt |
Corporate Director |
Jan 1, 2023 | |
| Nanette Banks |
Corporate Director |
Jan 1, 2023 | |
| Robert Musick |
Corporate Director |
Sep 17, 2024 | |
| Carlana G. Mullins |
Corporate Director |
Jan 1, 2013 | |
| Kathy Hall |
Corporate Director |
Jan 1, 2024 |
All facility ownership & control disclosures 4
| Facility | Type | Role | Since |
|---|---|---|---|
| Mountain Comprehensive Health Corporation |
Federally qualified health center | Operational/Managerial Control | Aug 1, 2012 |
| Letcher County Alternative Education School Based Clinic |
Federally qualified health center | Operational/Managerial Control | Aug 1, 2012 |
| Mountain Comprehensive Health Corporation |
Federally qualified health center | Operational/Managerial Control | Aug 1, 2012 |
| Mountain Comprehensive Health Corporation |
Federally qualified health center | Operational/Managerial Control | Aug 1, 2012 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031224000024 | KY | Part B Supplier - Clinic/Group Practice | 7618875873 |
Receives reassigned benefits from 92 practitioners 13 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Jeremiah, KY; Whitesburg, KY; Pineville, KY; Middlesboro, KY; Hindman, KY; Harlan, KY; Elkhorn City, KY; Cumberland, KY… |
| O20161021002118 | KY | Part a Provider - Federally Qualified Health Center (FQHC) | 7618875873 | Practice locations: Jeremiah, KY |
National Provider Directory
- Tax ID family
- MTN Comp Health Corp
Locations
132 Village Center Rd
Harlan, KY 40831
Phone (606) 573-2004
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | |||
| Primary Care Clinic/Center | 261QP2300X | Yes | ||
| Family Nurse Practitioner |
363LF0000X |
Addresses
Primary practice location
105 Isom PLZ
Jeremiah, KY 41826-9088
Mailing address
PO Box 40
Whitesburg, KY 41858-0040
Phone (606) 633-4823
Other providers in Jeremiah, KY
- Scotty Caudill
- East Kentucky Support Services Inc
- Gilley Enterprises LLC
- Letcher Voluntary Fire and Rescue Squad Inc
- Madison Meredith
All providers in Jeremiah, KY · Primary Care Clinic/Center in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 7, 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.