Basic Information
| Provider Information | |||||||||
| NPI: | 1225471980 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | APPALACHIAN REGIONAL MEDICAL ASSOCIATES, INC | ||||||||
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| OtherOrganizationName: | APPALACHIAN REGIONAL ORTHOPAEDIC AND SPORTS MEDICINE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 336 DEERFIELD RD | ||||||||
| Address2: | |||||||||
| City: | BOONE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286075008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282621211 | ||||||||
| FaxNumber: | 8282624103 | ||||||||
| Practice Location | |||||||||
| Address1: | 870 STATE FARM RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BOONE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286074861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283862663 | ||||||||
| FaxNumber: | 8283862664 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2013 | ||||||||
| LastUpdateDate: | 05/16/2013 | ||||||||
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| AuthorizedOfficialLastName: | LONG | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | ETTA | ||||||||
| AuthorizedOfficialTitleorPosition: | SR VP MEDICAL STAFF RELATIONS | ||||||||
| AuthorizedOfficialTelephone: | 8282624133 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.