Provider Demographics
NPI:1700828597
Name:BIG SANDY HEALTH CARE INC
Entity Type:Organization
Organization Name:BIG SANDY HEALTH CARE INC
Other - Org Name:SHELBY VALLEY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BOYCE
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SHOFNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-886-8546
Mailing Address - Street 1:1709 KY ROUTE 321
Mailing Address - Street 2:SUITE 3 BIG SANDY HEALTH CARE INC
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-9101
Mailing Address - Country:US
Mailing Address - Phone:606-886-8546
Mailing Address - Fax:606-886-8548
Practice Address - Street 1:178 DOUGLAS PKWY
Practice Address - Street 2:SHELBY VALLEY CLINIC
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-6970
Practice Address - Country:US
Practice Address - Phone:606-639-3135
Practice Address - Fax:606-639-3136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY700058261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY31000417Medicaid
3961Medicare ID - Type Unspecified
KY31000417Medicaid