Provider Demographics
NPI:1487891933
Name:APPALACHIAN REGIONAL MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:APPALACHIAN REGIONAL MEDICAL ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. VP MEDICAL STAFF RELATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ETTA
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-262-4133
Mailing Address - Street 1:155 FURMAN RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5049
Mailing Address - Country:US
Mailing Address - Phone:828-262-9127
Mailing Address - Fax:828-268-0742
Practice Address - Street 1:150 PARK AVE
Practice Address - Street 2:
Practice Address - City:BANNER ELK
Practice Address - State:NC
Practice Address - Zip Code:28604-6604
Practice Address - Country:US
Practice Address - Phone:828-262-9127
Practice Address - Fax:828-268-0742
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPALACHIAN REGIONAL MEDICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-20
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31158207R00000X
NC33815207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907786Medicaid