Healthcare Provider Details

I. General information

NPI: 1003380759
Provider Name (Legal Business Name): APPALACHIAN CENTER FOR EXCELLENCE IN HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 CENTRE AVE NE
COEBURN VA
24230-3502
US

IV. Provider business mailing address

116 CENTRE AVE NE
COEBURN VA
24230-4023
US

V. Phone/Fax

Practice location:
  • Phone: 276-455-5556
  • Fax: 267-455-5557
Mailing address:
  • Phone: 276-455-5556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: PAULA HILL
Title or Position: CLINICAL DIRECTOR
Credential: FNP
Phone: 276-455-5556