Provider Demographics
NPI:1609889328
Name:APPALACHIAN FAMILY PRACTICE, PA
Entity Type:Organization
Organization Name:APPALACHIAN FAMILY PRACTICE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:DAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-262-1011
Mailing Address - Street 1:1879 OLD 421 SOUTH
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-6293
Mailing Address - Country:US
Mailing Address - Phone:828-262-1011
Mailing Address - Fax:828-262-5695
Practice Address - Street 1:1879 OLD 421 SOUTH
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-6293
Practice Address - Country:US
Practice Address - Phone:828-262-1011
Practice Address - Fax:828-262-5695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC135VGOtherBCBS
NC89135VGMedicaid
NC89135VGMedicaid
NC135VGOtherBCBS