APPALACHIAN HIGHWAY MEDICAL & SURGICAL CLINIC, PLLC — NPI 1255403002 (Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center in PINEVILLE, WV)

CMS-1500 Box 24J / 33a • NPI

1255403002

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

261QM1300X (CMS 70)

Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center

Box 32 Service Location & ZIP+4

APPALACHIAN HWY, RT. 10 EAST PINEVILLE, PINEVILLE, WV, 24874-1274

✓ 9-Digit EDI 837 ZIP+4 (24874-1274)

Practice Phone & Referral Fax

(304) 732-9045

Fax: (304) 732-9055

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1255403002 (APPALACHIAN HIGHWAY MEDICAL & SURGICAL CLINIC, PLLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1255403002` (NPI-2 Organization / Facility)
Provider / Legal Name	APPALACHIAN HIGHWAY MEDICAL & SURGICAL CLINIC, PLLC
Plain-English Specialty	Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center NUCC Code: `261QM1300X` (Clinic/Center, Multi-Specialty)
Certifying / Licensing Body	Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Practice Location Address	APPALACHIAN HWY, RT. 10 EAST PINEVILLE, PINEVILLE, WV, 24874-1274
Practice Telephone / Fax	Tel: (304) 732-9045 \| Fax: (304) 732-9055
Administrative Mailing Address	APPALACHIAN HIGHWAY RT. 10 EAST PINEVILLE, PINEVILLE, WV, 24874-1274
Enumeration & Last Sync	Enumerated: 2006-11-15 \| CMS Record Updated: 2019-01-07
Authorized Official	DOMINADOR LAO (Physician)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

APPALACHIAN HWY, RT. 10 EAST PINEVILLE, PINEVILLE, WV, 24874-1274

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Plain-English Taxonomy & CMS Crosswalk (261QM1300X)

What Does Taxonomy Code 261QM1300X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 261QM1300X translates to:
"Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 70 (Clinic or Group Practice)
Certifying / Accrediting Authority: Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Clinical Scope: Same-day outpatient consultations, urgent walk-in medical care, vaccinations, and day-case diagnostic procedures.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (APPALACHIAN HIGHWAY MEDICAL & SURGICAL CLINIC, PLLC)

Typical CPT / Diagnostic Procedures:

Walk-In Urgent Care Evaluation, Point-of-Care Testing & X-Ray
Same-Day Ambulatory Endoscopy, Cataract & Minor Surgical Procedures

Common Therapeutic Classes:

Outpatient Oral Antimicrobials, Analgesics, Nebulizers & Vaccines

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`261QM1300X` — Clinic/Center, Multi-Specialty Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: WV \| License: `12700` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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APPALACHIAN HIGHWAY MEDICAL & SURGICAL CLINIC, PLLC (NPI #1255403002)