Healthcare Provider Details

I. General information

NPI: 1225380389
Provider Name (Legal Business Name): APPALACHIAN REGIONAL HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2012
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 BLACK GOLD BLVD STE 210
HAZARD KY
41701-2620
US

IV. Provider business mailing address

100 AIRPORT GARDENS RD
HAZARD KY
41701-9529
US

V. Phone/Fax

Practice location:
  • Phone: 606-487-7000
  • Fax: 606-487-7022
Mailing address:
  • Phone: 606-439-0447
  • Fax: 606-436-0408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. HOLLIE HARRIS
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 859-226-2511