Provider Demographics
NPI:1508518689
Name:PPADBVL LLC
Entity Type:Organization
Organization Name:PPADBVL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:STOKER
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:828-575-6421
Mailing Address - Street 1:730 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28714-3102
Mailing Address - Country:US
Mailing Address - Phone:828-678-1121
Mailing Address - Fax:828-678-3945
Practice Address - Street 1:730 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-3102
Practice Address - Country:US
Practice Address - Phone:828-678-1121
Practice Address - Fax:828-678-3945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty