Healthcare Provider Details

I. General information

NPI: 1730457987
Provider Name (Legal Business Name): APPALACHIAN COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 YOKUM ST
ELKINS WV
26241-3353
US

IV. Provider business mailing address

725 YOKUM ST
ELKINS WV
26241-3353
US

V. Phone/Fax

Practice location:
  • Phone: 304-636-3232
  • Fax: 304-636-9243
Mailing address:
  • Phone: 304-636-3232
  • Fax: 304-636-9243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number1
License Number StateWV

VIII. Authorized Official

Name: DR. RICHARD H KILEY JR.
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D.
Phone: 304-636-3232