Provider Demographics
NPI:1376852673
Name:APPALACHIAN EMERGENCY PHYSICIANS
Entity Type:Organization
Organization Name:APPALACHIAN EMERGENCY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF BLUE RIDGE MEDICAL MGT
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:S
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-916-5259
Mailing Address - Street 1:PO BOX 534964
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-4950
Mailing Address - Country:US
Mailing Address - Phone:866-916-5259
Mailing Address - Fax:231-922-4030
Practice Address - Street 1:245 MEDICAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-6587
Practice Address - Country:US
Practice Address - Phone:276-782-1234
Practice Address - Fax:276-378-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1376852673Medicaid
WV3810019394Medicaid
NC5916313Medicaid
KY7100142680Medicaid
VAVAA103823Medicare PIN