Provider Demographics
NPI:1982648010
Name:APPALACHIAN REGIONAL HEALTHCARE, INC.
Entity Type:Organization
Organization Name:APPALACHIAN REGIONAL HEALTHCARE, INC.
Other - Org Name:ARH MORGAN COUNTY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CHIEF EXECUTIVE OFFIC
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:I
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-226-2492
Mailing Address - Street 1:476 LIBERTY ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:41472
Mailing Address - Country:US
Mailing Address - Phone:606-743-3198
Mailing Address - Fax:606-743-1655
Practice Address - Street 1:476 LIBERTY ROAD
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:41472
Practice Address - Country:US
Practice Address - Phone:606-743-3198
Practice Address - Fax:606-743-1655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY700107261QP2300X
KY900129261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100350270Medicaid
KY31000748Medicaid
KY030624300OtherBLACK LUNG
KY030624300OtherBLACK LUNG
KY183451Medicare ID - Type UnspecifiedMEDICARE GROUP #