1407093990 NPI number — APPALACHIAN REGIONAL MEDICAL ASSOCIATES

Table of content: (NPI 1407093990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407093990 NPI number — APPALACHIAN REGIONAL MEDICAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APPALACHIAN REGIONAL MEDICAL ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WATAUGA INTERNAL MEDICINE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407093990
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 FURMAN RD
Provider Second Line Business Mailing Address:
SUITE 7
Provider Business Mailing Address City Name:
BOONE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28607-5049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-262-9125
Provider Business Mailing Address Fax Number:
828-268-0742

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
136 FURMAN RD
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
BOONE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28607-5038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-262-0060
Provider Business Practice Location Address Fax Number:
828-262-0062
Provider Enumeration Date:
01/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LONG
Authorized Official First Name:
MARY
Authorized Official Middle Name:
ETTA
Authorized Official Title or Position:
SR VP MEDICAL STAFF RELATIONS
Authorized Official Telephone Number:
828-262-4133

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  33835 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 27800 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 28595 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5906476 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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