Provider Demographics
NPI:1235645607
Name:APPALACHIAN VASCULAR INSTITUTE, PLLC
Entity Type:Organization
Organization Name:APPALACHIAN VASCULAR INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-439-0051
Mailing Address - Street 1:243 ROY CAMPBELL DR STE B
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9485
Mailing Address - Country:US
Mailing Address - Phone:606-439-0051
Mailing Address - Fax:606-439-0516
Practice Address - Street 1:243 ROY CAMPBELL DR STE B
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9485
Practice Address - Country:US
Practice Address - Phone:606-439-4433
Practice Address - Fax:606-487-8035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-21
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty