Basic Information
| Provider Information | |||||||||
| NPI: | 1679658199 | ||||||||
| EntityType: | 2 | ||||||||
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| 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: | 260 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | SOUTH WILLIAMSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 415034072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062371700 | ||||||||
| FaxNumber: | 6062371701 | ||||||||
| 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: | 08/19/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | HOLLIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 8592262511 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 2085R0202X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 207ZP0102X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 0001551005 | 05 | WV | MEDICAID | 65905283 | 05 | KY | MEDICAID |