Provider Demographics
NPI:1477638880
Name:MOUNTAIN AFTER HOURS CLINIC PSC
Entity type:Organization
Organization Name:MOUNTAIN AFTER HOURS CLINIC PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:T
Authorized Official - Last Name:YONTS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:606-436-0711
Mailing Address - Street 1:1908 N MAIN ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-2505
Mailing Address - Country:US
Mailing Address - Phone:606-439-2662
Mailing Address - Fax:
Practice Address - Street 1:1908 N MAIN ST
Practice Address - Street 2:SUITE 120
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-2505
Practice Address - Country:US
Practice Address - Phone:606-439-2662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY900091261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100822290Medicaid
KY183857Medicare Oscar/Certification
KY183857Medicare PIN