Provider Demographics
NPI:1346419926
Name:KENTUCKY MOUNTAIN HEALTH, LLC
Entity Type:Organization
Organization Name:KENTUCKY MOUNTAIN HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEADOWS
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:606-433-0404
Mailing Address - Street 1:101 HIBBARD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1788
Mailing Address - Country:US
Mailing Address - Phone:606-433-0404
Mailing Address - Fax:606-432-0405
Practice Address - Street 1:101 HIBBARD ST STE 100
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1788
Practice Address - Country:US
Practice Address - Phone:606-433-0404
Practice Address - Fax:606-432-0405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY18D1083376OtherCLIA