Provider Demographics
NPI:1407093990
Name:APPALACHIAN REGIONAL MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:APPALACHIAN REGIONAL MEDICAL ASSOCIATES
Other - Org Name:WATAUGA INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP MEDICAL STAFF RELATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ETTA
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-262-4133
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 1:136 FURMAN RD
Practice Address - Street 2:SUITE 7
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5038
Practice Address - Country:US
Practice Address - Phone:828-262-0060
Practice Address - Fax:828-262-0062
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPALACHIAN REGIONAL MEDICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-21
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33835207R00000X
NC27800207R00000X
NC28595207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5906476Medicaid