Provider Demographics
NPI:1962823393
Name:JUNIPER HEALTH, INC
Entity Type:Organization
Organization Name:JUNIPER HEALTH, INC
Other - Org Name:JHI WOLFE COUNTY FAMILY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DITSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
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 1:202 PLUMMER STREET
Practice Address - Street 2:
Practice Address - City:CAMPTON
Practice Address - State:KY
Practice Address - Zip Code:41301-7879
Practice Address - Country:US
Practice Address - Phone:606-668-7385
Practice Address - Fax:606-668-7009
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JUNIPER HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-03
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY700132A261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY181919OtherMEDICARE FQHC PTAN
KY31000862Medicaid
KY9521OtherMEDICARE PART B