Provider Demographics
NPI:1083851539
Name:APPALACHIAN REGIONAL MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:APPALACHIAN REGIONAL MEDICAL ASSOCIATES
Other - Org Name:APPALACHIAN REGIONAL OBSTETRICS AND GYNECOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:MELIKANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-262-9125
Mailing Address - Street 1:155 FURMAN RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5049
Mailing Address - Country:US
Mailing Address - Phone:828-262-9125
Mailing Address - Fax:828-268-0742
Practice Address - Street 1:166 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5000
Practice Address - Country:US
Practice Address - Phone:828-264-9067
Practice Address - Fax:828-264-9068
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPALACHIAN REGIONAL MEDICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-20
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33834207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5950292Medicaid