MEDICARE: APPALACHIAN HEALTHCARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center	18588	NC

General Provider Information

NPI Number	:	1578702189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPALACHIAN HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	9330 HWY 194
Second Line	:
City	:	LANSING
State	:	NC
Zip	:	28643-0184
Country	:	US
Telephone Number	:	919-614-3028
Fax Number	:	919-303-1533

Provider Business Practice Location Address
First Line	:	9330 HIGHWAY 194
Second Line	:
City	:	LANSING
State	:	NC
Zip	:	28643-0184
Country	:	US
Telephone Number	:	919-614-3028
Fax Number	:	919-303-1533

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JUDY KATHLEEN ERNST-HOPP
Credential	:
Telephone Number	:	919-614-3028

Provider Enumeration Date	:	02/05/2009
Last Update Date	:	02/05/2009

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