1942246970 NPI number — BIG SANDY HEALTH CARE INC

Table of content: (NPI 1942246970)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942246970 NPI number — BIG SANDY HEALTH CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIG SANDY HEALTH CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942246970
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1709 KY ROUTE 321
Provider Second Line Business Mailing Address:
SUITE 3 BIG SANDY HEALTH CARE INC
Provider Business Mailing Address City Name:
PRESTONSBURG
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41653-9101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-886-8546
Provider Business Mailing Address Fax Number:
606-886-8548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7629 KY ROUTE 979
Provider Second Line Business Practice Location Address:
MUD CREEK CLINIC PHARMACY
Provider Business Practice Location Address City Name:
GRETHEL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41631-6304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-587-2200
Provider Business Practice Location Address Fax Number:
855-217-1130
Provider Enumeration Date:
06/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HERALD
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
606-886-8546

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X , with the licence number:  P01238 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 54019492 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com