Healthcare Provider Details

I. General information

NPI: 1568542009
Provider Name (Legal Business Name): APPALACHIA HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 N MAIN ST
JELLICO TN
37762-2132
US

IV. Provider business mailing address

292 N MAIN ST
JELLICO TN
37762-2132
US

V. Phone/Fax

Practice location:
  • Phone: 423-784-3600
  • Fax: 423-784-4602
Mailing address:
  • Phone: 423-784-3600
  • Fax: 423-784-4602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberMD0000027929
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD0000025677
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD0000026093
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD0000021416
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD0000030920
License Number StateTN

VIII. Authorized Official

Name: DAVID A. ESCALANTE
Title or Position: CEO
Credential: MD
Phone: 423-784-3600