Provider Demographics
NPI:1740382795
Name:APPALACHIAN REGIONAL HEALTHCARE, INC.
Entity Type:Organization
Organization Name:APPALACHIAN REGIONAL HEALTHCARE, INC.
Other - Org Name:MIDDLESBORO ARH PHYSICIAN'S SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-226-2511
Mailing Address - Street 1:3602 WEST CUMBERLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-0340
Mailing Address - Country:US
Mailing Address - Phone:606-242-1463
Mailing Address - Fax:606-242-1111
Practice Address - Street 1:3602 WEST CUMBERLAND AVENUE
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-0340
Practice Address - Country:US
Practice Address - Phone:606-242-1463
Practice Address - Fax:606-242-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10019174400000X
363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65926834Medicaid
KY65926834Medicaid
KY0631Medicare ID - Type UnspecifiedGROUP NUMBER