Provider Demographics
NPI:1841764271
Name:DAYSPRING HEALTH INC
Entity Type:Organization
Organization Name:DAYSPRING HEALTH INC
Other - Org Name:DAYSPRING DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-784-8492
Mailing Address - Street 1:PO BOX 540
Mailing Address - Street 2:
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762-0540
Mailing Address - Country:US
Mailing Address - Phone:423-784-8492
Mailing Address - Fax:423-455-0380
Practice Address - Street 1:640 W HIGHWAY 92 STE 3
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1936
Practice Address - Country:US
Practice Address - Phone:606-765-6080
Practice Address - Fax:606-549-2855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-18
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY31000946Medicaid
TNQ055857Medicaid
KY7100191350Medicaid
KY9042OtherSTATE LICENSE
KY10107OtherSTATE LICENSE
KY7100553680Medicaid
KY7100553680Medicaid
KYFR7599206OtherDEA