Provider Demographics
NPI:1669588505
Name:JUNIPER HEALTH INC
Entity type:Organization
Organization Name:JUNIPER HEALTH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO, CEO
Authorized Official - Phone:606-666-9950
Mailing Address - Street 1:141 MAIN STREET
Mailing Address - Street 2:P.O. BOX 690
Mailing Address - City:BEATTYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41311
Mailing Address - Country:US
Mailing Address - Phone:606-464-0151
Mailing Address - Fax:606-464-0152
Practice Address - Street 1:141 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BEATTYVILLE
Practice Address - State:KY
Practice Address - Zip Code:41311
Practice Address - Country:US
Practice Address - Phone:606-464-0151
Practice Address - Fax:606-464-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY700132261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY31000862Medicaid
KY31000854Medicaid
KY181853Medicare ID - Type UnspecifiedBREATHITT COUNTY UGS
KY181848Medicare ID - Type UnspecifiedLEE COUNTY UGS
KY9521Medicare ID - Type UnspecifiedADMINISTAR FEDERAL