Provider Demographics
NPI:1598703043
Name:APPALACHIAN ORTHOPAEDIC ASSOCIATES, PC
Entity Type:Organization
Organization Name:APPALACHIAN ORTHOPAEDIC ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KISIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-239-1550
Mailing Address - Street 1:4105 FORT HENRY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2240
Mailing Address - Country:US
Mailing Address - Phone:423-239-1550
Mailing Address - Fax:423-239-1544
Practice Address - Street 1:2202 JOHN B DENNIS HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660
Practice Address - Country:US
Practice Address - Phone:423-245-3161
Practice Address - Fax:423-857-8129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNCD1842OtherRAILROAD MEDICARE
TN3710612Medicaid
TN0443950001Medicare NSC
TN3710612Medicare PIN