Provider Demographics
NPI:1487727459
Name:APPALACHIAN DISTRICT HEALTH DEPARTMENT
Entity type:Organization
Organization Name:APPALACHIAN DISTRICT HEALTH DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALER/BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-246-9449
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-0208
Mailing Address - Country:US
Mailing Address - Phone:336-246-9449
Mailing Address - Fax:336-982-3555
Practice Address - Street 1:126 POPLAR GROVE CONNECTOR
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5915
Practice Address - Country:US
Practice Address - Phone:828-264-4995
Practice Address - Fax:828-264-4997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0709WOtherBLUE CROSS BLUE SHIELD
NC3404395Medicaid
NC0709WOtherBLUE CROSS BLUE SHIELD