Provider Demographics
NPI:1740844067
Name:APPALACHIAN MEDICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:APPALACHIAN MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-803-8372
Mailing Address - Street 1:PO BOX 884
Mailing Address - Street 2:
Mailing Address - City:RAVEN
Mailing Address - State:VA
Mailing Address - Zip Code:24639
Mailing Address - Country:US
Mailing Address - Phone:276-345-4433
Mailing Address - Fax:276-345-4424
Practice Address - Street 1:5453 GOV. G.C. PEERY HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:RAVEN
Practice Address - State:VA
Practice Address - Zip Code:24639
Practice Address - Country:US
Practice Address - Phone:276-245-4433
Practice Address - Fax:276-345-4424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder