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General NPI Number Information
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NPI Number | 1235645607
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Entity Type | Organization
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Legal Business Name | APPALACHIAN VASCULAR INSTITUTE, PLLC
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Dates
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Enumeration Date | 12/21/2017
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Last Update Date | 04/18/2018
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Provider Practice Location Address
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Address Line | 243 ROY CAMPBELL DR STE B
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City | HAZARD
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State | KY
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Zip | 41701-9485
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Country | US
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Telephone | 606-439-4433
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Fax | 606-487-8035
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Provider Business Mailing Address
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Address Line | 243 ROY CAMPBELL DR STE B
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City | HAZARD
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State | KY
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Zip | 41701-9485
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Country | US
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Telephone | 606-439-0051
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Fax | 606-439-0516
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | THERESA WELLS
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Credential |
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Telephone | 606-439-0051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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