Basic Information
| Provider Information | |||||||||
| NPI: | 1083799506 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | APPALACHIAN REGIONAL HEALTHCARE, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TUG VALLEY ARH REGIONAL MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 AIRPORT GARDENS RD | ||||||||
| Address2: | |||||||||
| City: | HAZARD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 417019529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062165145 | ||||||||
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| Practice Location | |||||||||
| Address1: | 260 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | SOUTH WILLIAMSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 415034072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062371700 | ||||||||
| FaxNumber: | 6062371701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 05/17/2021 | ||||||||
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| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | HOLLIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 8592262511 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 000000063666 | 01 | KY | KY BLUE CROSS REF LAB | OTHER |