Healthcare Provider Details

I. General information

NPI: 1053336636
Provider Name (Legal Business Name): APPALACHIAN FAMILY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18765 RIVERSIDE DRIVE
VANSANT VA
24656
US

IV. Provider business mailing address

PO BOX 498
KEEN MOUNTAIN VA
24624-0498
US

V. Phone/Fax

Practice location:
  • Phone: 276-935-2880
  • Fax: 276-935-2889
Mailing address:
  • Phone: 276-935-2880
  • Fax: 276-935-2889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: FRANCES BAXTER MINTON
Title or Position: PRESIDENT
Credential: RN
Phone: 276-935-2880