Appalachian Wellness Primary Care LLC
Organization Active NPI Rural Health Clinic/Center · Campton, KY
NPI 1396488656 · NPPES record last updated Aug 10, 2022
Key facts
- NPI
- 1396488656
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- APPALACHIAN WELLNESS PRIMARY CARE LLC
- Practice address
- 592 Ky 15 S Ste 1-2
Campton, KY 41301-9552 - Phone
- (606) 668-9178
- Fax
- (877) 203-3485
- NPI assigned
- Apr 15, 2022
- Organization subpart
- No
Authorized official
- Name
- Miss Sheri Rose Haas
- Title
- Owner
- Phone
- (606) 668-9178
Owners & managing parties with NPI records 1
-
Sheri Lyn Rose Haas, M.A., L.P.P.
Practitioners 11
-
Sheri Lyn Rose Haas, M.A., L.P.P.
-
Jessi Jade Campbell, APRN
-
Scott A Haas, M.D.
-
Aaron Oliver, LPCA
-
Tami Osborne, APRN
-
Dhruv Pandya, MD
-
Manish Parikh, MD
-
Carmen Rogers, LPA
-
Edward Allen Sizemore, ARNP, NP-C
-
Courtney Louise Feral, APRN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Rural health clinic certification: CCN B03919
- Legal name
- APPALACHIAN WELLNESS PRIMARY CARE LLC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Mar 30, 2023
- Last certification
- Mar 30, 2023
- Ownership / control type
- 1A
- Organization structure
- Other · Proprietary
- Incorporated
- Mar 16, 2022 in KY
- Enrollment address
- 592 Ky 15 S
Ste 1-2
Campton, KY 41301-9552
All disclosed owners & managing parties 1
| Name | Role | Since | Share |
|---|---|---|---|
| Sheri Lyn Rose Haas |
Contracted Managing Employee | Mar 16, 2022 | 100% |
| 5% Or Greater Direct Ownership Interest | Mar 16, 2022 | 100% | |
| Corporate Officer | Mar 16, 2022 | 100% | |
| W-2 Managing Employee | Mar 16, 2022 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221110002901 | KY | Part a Provider - Rural Health Clinic | 4789051350 | Practice locations: Campton, KY |
National Provider Directory
Locations
1850 Bypass Rd
Winchester, KY 40391
Phone (859) 744-5111
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
592 Ky 15 S Ste 1-2
Campton, KY 41301-9552
Mailing address
592 Ky 15 S Ste 1-2
Campton, KY 41301-9552
Phone (606) 668-9178
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | officeally |
Other providers in Campton, KY
- Kristian Renee Allen
- Allergy Asthma and Immunology
- Ambulatory Care Services PLLC
- Tammy Renee Angel
- Appalachian Wellness Laboratory Services
- Appalachian Wellness, L.L.C.
- Adrian Clint Banks
- Alissa Leigh Bell
- Sandra Kaye Benham
- Carla Bowling
All providers in Campton, KY · Rural Health Clinic/Center in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 10, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.