Appalachian Center for Excellence and Healthcare, Inc.
Organization Active NPI Rural Health Clinic/Center · Coeburn, VA
NPI 1669294385 · NPPES record last updated Oct 28, 2024
Key facts
- NPI
- 1669294385
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- APPALACHIAN CENTER FOR EXCELLENCE AND HEALTHCARE, INC.
- Practice address
- 116 Centre Ave NE
Coeburn, VA 24230-4023 - Phone
- (276) 455-5556
- NPI assigned
- Oct 25, 2024
- Organization subpart
- No
Authorized official
- Name
- Paula Hill-Collins
- Title
- Vice President
- Phone
- (276) 337-0331
Owners & managing parties with NPI records 1
-
Teresa Tyson, FNP-BC
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 2
Practitioners 15
-
Ethan Collins, FNP
-
Cara Robinson, FNP-BC
-
Jazlyn Whitney Rowe, FNP-C
-
Ashley Stanley, FNP-BC
-
Leandra Stanley, PMHNP-BC
-
Teresa Tyson, FNP-BC
-
Ramona L Boyd, NP
-
Tauna Gulley, PHD, FNP, MSN
-
Christine Michelle Mullins, DNP, FNP-C
-
Rebecca J Mullins, FNP
-
Joseph F Smiddy, M.D.
-
Allison Heather Stanley, FNP-C
-
Henry Price Viers, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Rural health clinic certification: CCN 493879
- Legal name
- APPALACHIAN CENTER FOR EXCELLENCE AND HEALTHCARE INC
- Doing business as
- ST. MARY'S CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- May 29, 2025
- Last certification
- May 29, 2025
- Ownership / control type
- 1B
- Organization structure
- Corporation · Proprietary
- Enrollment address
- 116 Centre Ave NE
Coeburn, VA 24230-4023
All disclosed owners & managing parties 1
| Name | Role | Since | Share |
|---|---|---|---|
| Teresa Tyson |
5% Or Greater Direct Ownership Interest |
Oct 14, 2019 | 100% |
| W-2 Managing Employee |
Oct 14, 2019 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250318003589 | VA | Part a Provider - Rural Health Clinic | 6507108545 | Practice locations: Coeburn, VA |
National Provider Directory
- Tax ID family
- St Marys Health Wagon
Locations
927 Happy Valley Dr
Clintwood, VA 24228
Phone (276) 455-5556
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
116 Centre Ave NE
Coeburn, VA 24230-4023
Mailing address
927 Happy Valley Drive
Clintwood, VA 24228-7100
Phone (276) 455-5556
Other practice location 1
927 Happy Valley Drive
Clintwood, VA 24230-4023
Phone (276) 455-5556
Other providers in Coeburn, VA
- Dustin Lee Adkins
- Apothecary Enterprises, LTD
- Apothecary Enterprises, LTD.
- Appalachian Center for Excellence and Healthcare, Inc.
- Appalachian Center for Excellence in Healthcare Inc
- Burley Walter Ball Jr.
- Ashley Bond
- Amy Zeigler Bradley
- Scott Brooks
All providers in Coeburn, VA · Rural Health Clinic/Center in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 28, 2024. 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.