=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669294385
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APPALACHIAN CENTER FOR EXCELLENCE AND HEALTHCARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2024
-----------------------------------------------------
Last Update Date | 10/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 116 CENTRE AVE NE
-----------------------------------------------------
City | COEBURN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24230-4023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-455-5556
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 927 HAPPY VALLEY DRIVE
-----------------------------------------------------
City | CLINTWOOD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24228-7100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-455-5556
-----------------------------------------------------
Fax | 274-455-5554
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | PAULA HILL-COLLINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 276-337-0331
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------