Provider Demographics
NPI:1942246970
Name:BIG SANDY HEALTH CARE INC
Entity Type:Organization
Organization Name:BIG SANDY HEALTH CARE INC
Other - Org Name:MUD CREEK CLINIC PHARMACY
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 1:7629 KY ROUTE 979
Practice Address - Street 2:MUD CREEK CLINIC PHARMACY
Practice Address - City:GRETHEL
Practice Address - State:KY
Practice Address - Zip Code:41631-6304
Practice Address - Country:US
Practice Address - Phone:606-587-2200
Practice Address - Fax:606-587-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP012383336C0002X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54019492Medicaid
KY54019492Medicaid