Provider Demographics
NPI:1710489273
Name:APPALACHIAN REGIONAL MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:APPALACHIAN REGIONAL MEDICAL ASSOCIATES INC
Other - Org Name:APPALACHIAN GASTROENTEROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP MEDICAL STAFF RELATIONS
Authorized Official - Prefix:
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 1:336 DEERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5008
Mailing Address - Country:US
Mailing Address - Phone:828-264-0029
Mailing Address - Fax:828-262-4103
Practice Address - Street 1:APPGASTRO - ASC
Practice Address - Street 2:870 STATE FARM RD, STE 102
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607
Practice Address - Country:US
Practice Address - Phone:828-264-0029
Practice Address - Fax:828-262-4103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RG0100X
NCAS0095261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty