1952505612 NPI number — APPALACHIA HEALTH SERVICES LLC

Table of content: (NPI 1952505612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952505612 NPI number — APPALACHIA HEALTH SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APPALACHIA HEALTH SERVICES LLC
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:
1952505612
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
292 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JELLICO
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37762-2132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-784-3600
Provider Business Mailing Address Fax Number:
423-784-4602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3080 US HWY 25 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40769-8602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-549-9107
Provider Business Practice Location Address Fax Number:
606-549-9862
Provider Enumeration Date:
06/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ESCALANTE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
423-784-3600

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  900133 , 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)





Copyright © 2007-2025 www.npivalidator.com