| Grace Sbhc Middlesboro High School | |
|
4404 W Cumberland Ave Middlesboro KY 40965-2626 | |
| (606) 242-8820 | |
| (606) 242-8825 |
| Full Name | Grace Sbhc Middlesboro High School |
|---|---|
| Speciality | Clinic/Center |
| Location | 4404 W Cumberland Ave, Middlesboro, Kentucky |
| Authorized Official Name and Position | Chad Stevens (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 6065269005 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Sbhc Middlesboro High School 1019 Cumberland Falls Hwy Ste B201 Corbin KY 40701-2793 Ph: () - | Grace Sbhc Middlesboro High School 4404 W Cumberland Ave Middlesboro KY 40965-2626 Ph: (606) 242-8820 |
| NPI Number | 1356987978 |
|---|---|
| Provider Enumeration Date | 11/19/2019 |
| Last Update Date | 06/28/2024 |
| Medicare PECOS PAC ID | 3870654064 |
|---|---|
| Medicare Enrollment ID | O20200225000721 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356987978 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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