1134670607 NPI number — APPALACHIAN DISTRICT HEALTH DEPARTMENT

Table of content: (NPI 1134670607)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134670607 NPI number — APPALACHIAN DISTRICT HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APPALACHIAN DISTRICT HEALTH DEPARTMENT
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:
APPHEALTH DENTAL-SBHC
Provider Other Organization Name Type Code:
5
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:
1134670607
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 208
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEFFERSON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28640-0208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-246-9449
Provider Business Mailing Address Fax Number:
336-246-8163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 NORTHWEST LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARRENSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28693-9244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-384-1625
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2016

Additional Information

Authorized Official

Authorized Official Last Name:
LOVETTE
Authorized Official First Name:
DARYL
Authorized Official Middle Name:
BETH
Authorized Official Title or Position:
HEALTH DIRECTOR
Authorized Official Telephone Number:
828-264-4995

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  10356 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1285081562 . This is a "NPI FOR MEDICAL CLINIC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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