Basic Information
Provider Information | |||||||||
NPI: | 1144748948 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | APPALACHIAN REGIONAL MEDICAL ASSOCIATES INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | WATAUGA SURGICAL GROUP | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 336 DEERFIELD RD | ||||||||
Address2: |   | ||||||||
City: | BOONE | ||||||||
State: | NC | ||||||||
PostalCode: | 286075008 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8282631211 | ||||||||
FaxNumber: | 8282624103 | ||||||||
Practice Location | |||||||||
Address1: | 965 STATE FARM RD | ||||||||
Address2: |   | ||||||||
City: | BOONE | ||||||||
State: | NC | ||||||||
PostalCode: | 286074948 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8282642340 | ||||||||
FaxNumber: | 8282620731 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/01/2017 | ||||||||
LastUpdateDate: | 09/01/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | LONG | ||||||||
AuthorizedOfficialFirstName: | MARY | ||||||||
AuthorizedOfficialMiddleName: | ETTA | ||||||||
AuthorizedOfficialTitleorPosition: | SR VP MEDICAL STAFF RELATIONS | ||||||||
AuthorizedOfficialTelephone: | 8282624133 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | RHIA CPMSM | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X |   | NC | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |   |
No ID Information.