1669781993 NPI number — APPALACHIAN EMERGENCY PHYSICIANS

Table of content: (NPI 1669781993)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669781993 NPI number — APPALACHIAN EMERGENCY PHYSICIANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APPALACHIAN EMERGENCY PHYSICIANS
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:
Provider Other Organization Name Type Code:
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:
1669781993
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 534964
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30353-4950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-916-5259
Provider Business Mailing Address Fax Number:
231-922-4030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
312 HOSPITAL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTWOOD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24228-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-916-5259
Provider Business Practice Location Address Fax Number:
231-922-4030
Provider Enumeration Date:
10/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KILGORE
Authorized Official First Name:
CARL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT OF BLUE RIDGE MEDICAL MGT
Authorized Official Telephone Number:
866-916-5259

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7100142630 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1669781993 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6999717 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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