Provider Demographics
NPI:1821196148
Name:APPALACHIAN ORTHOPAEDIC ASSOCIATES P C
Entity Type:Organization
Organization Name:APPALACHIAN ORTHOPAEDIC ASSOCIATES P C
Other - Org Name:APPALACHIAN REHABILITATION AND SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-239-1550
Mailing Address - Street 1:4105 FORT HENRY DR
Mailing Address - Street 2:STE 300
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2256
Mailing Address - Country:US
Mailing Address - Phone:423-239-1550
Mailing Address - Fax:423-239-1544
Practice Address - Street 1:105 MEADOWVIEW RD
Practice Address - Street 2:STE 4
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1725
Practice Address - Country:US
Practice Address - Phone:423-844-6935
Practice Address - Fax:423-844-6937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3658004Medicaid
TNCD1842OtherMEDICARE RAILROAD
TN3658004Medicare PIN
TN0443950007Medicare NSC