Provider Demographics
NPI:1952505612
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 1:3080 US HWY 25 W
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-8602
Practice Address - Country:US
Practice Address - Phone:606-549-9107
Practice Address - Fax:606-549-9862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY900133261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN443931Medicare Oscar/Certification
KY183893Medicare Oscar/Certification