Provider Demographics
NPI:1669014627
Name:JUNIPER HEALTH INC
Entity Type:Organization
Organization Name:JUNIPER HEALTH INC
Other - Org Name:JUNIPER HEALTH ELLIOTT COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO CEO
Authorized Official - Phone:606-464-0151
Mailing Address - Street 1:PO BOX 690
Mailing Address - Street 2:
Mailing Address - City:BEATTYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41311-0690
Mailing Address - Country:US
Mailing Address - Phone:606-464-0151
Mailing Address - Fax:606-464-0152
Practice Address - Street 1:308 N KY 7
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:KY
Practice Address - Zip Code:41171-9137
Practice Address - Country:US
Practice Address - Phone:606-738-9785
Practice Address - Fax:859-317-2148
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JUNIPER HEALTH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-11
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY31000862Medicaid