Provider Demographics
NPI:1396488656
Name:APPALACHIAN WELLNESS PRIMARY CARE LLC
Entity type:Organization
Organization Name:APPALACHIAN WELLNESS PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-668-9178
Mailing Address - Street 1:592 KY 15 S STE 1-2
Mailing Address - Street 2:
Mailing Address - City:CAMPTON
Mailing Address - State:KY
Mailing Address - Zip Code:41301-9552
Mailing Address - Country:US
Mailing Address - Phone:606-668-9178
Mailing Address - Fax:877-203-3485
Practice Address - Street 1:592 KY 15 S STE 1-2
Practice Address - Street 2:
Practice Address - City:CAMPTON
Practice Address - State:KY
Practice Address - Zip Code:41301-9552
Practice Address - Country:US
Practice Address - Phone:606-668-9178
Practice Address - Fax:877-203-3485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-15
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health