Healthcare Provider Details

I. General information

NPI: 1235645607
Provider Name (Legal Business Name): APPALACHIAN VASCULAR INSTITUTE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 ROY CAMPBELL DR STE B
HAZARD KY
41701-9485
US

IV. Provider business mailing address

243 ROY CAMPBELL DR STE B
HAZARD KY
41701-9485
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-4433
  • Fax: 606-487-8035
Mailing address:
  • Phone: 606-439-0051
  • Fax: 606-439-0516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: THERESA WELLS
Title or Position: OFFICE MANAGER
Credential:
Phone: 606-439-0051