Provider Demographics
NPI:1568542009
Name:APPALACHIA HEALTH SERVICES
Entity Type:Organization
Organization Name:APPALACHIA HEALTH SERVICES
Other - Org Name:APPALACHIA HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESCALANTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-784-3600
Mailing Address - Street 1:292 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762-2132
Mailing Address - Country:US
Mailing Address - Phone:423-784-3600
Mailing Address - Fax:423-784-4602
Practice Address - Street 1:292 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JELLICO
Practice Address - State:TN
Practice Address - Zip Code:37762-2132
Practice Address - Country:US
Practice Address - Phone:423-784-3600
Practice Address - Fax:423-784-4602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000027929204D00000X
TNMD0000030920207R00000X
MD0000025677207RE0101X
TNMD0000026093207RP1001X
TNMD0000021416208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG78616Medicare UPIN
TNF94706Medicare UPIN
TN3708723Medicare PIN
TNE51026Medicare UPIN