| Bhg Lviii, Llc | |
|
118 Grand Vue Plz Ste 118 Hazard KY 41701-6842 | |
| (606) 487-1646 | |
| Not Available |
| Full Name | Bhg Lviii, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 118 Grand Vue Plz Ste 118, Hazard, Kentucky |
| Authorized Official Name and Position | Jay Higham (CEO) |
| Authorized Official Contact | 2143656112 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bhg Lviii, Llc 5001 Spring Valley Road Suite 600 East Dallas TX 75244 Ph: (214) 365-6100 | Bhg Lviii, Llc 118 Grand Vue Plz Ste 118 Hazard KY 41701-6842 Ph: (606) 487-1646 |
| NPI Number | 1417696543 |
|---|---|
| Provider Enumeration Date | 05/27/2022 |
| Last Update Date | 09/27/2024 |
| Certification Date | 09/27/2024 |
| Medicare PECOS PAC ID | 4284002783 |
|---|---|
| Medicare Enrollment ID | O20221114002932 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417696543 | NPI | - | NPPES |
| Provider Name | Irwin Randell Cohen |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1376547711 PECOS PAC ID: 8325233125 Enrollment ID: I20210819003764 |
| Provider Name | Lilian Kigonya |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932375110 PECOS PAC ID: 4284788654 Enrollment ID: I20230913000346 |
| Provider Name | Cheyenne Dakota Hubbard |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003687559 PECOS PAC ID: 8123464187 Enrollment ID: I20240312004199 |
| Provider Name | Amanda Soudom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467223685 PECOS PAC ID: 2860831930 Enrollment ID: I20240423000089 |
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