Provider Demographics
NPI:1508003203
Name:APPALACHIAN REGIONAL MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:APPALACHIAN REGIONAL MEDICAL ASSOCIATES
Other - Org Name:APPALACHIAN REGIONAL ADULT AND FAMILY 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 1:166 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5000
Mailing Address - Country:US
Mailing Address - Phone:828-262-9125
Mailing Address - Fax:828-268-0742
Practice Address - Street 1:400 SHADOWLINE DR
Practice Address - Street 2:SUITE104
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5089
Practice Address - Country:US
Practice Address - Phone:828-268-1187
Practice Address - Fax:828-262-9728
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPALACHIAN REGIONAL MEDICAL ASSOICATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-16
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300057207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907784Medicaid