Provider Demographics
NPI:1568838639
Name:APPALACHIAN WELLNESS PLLC
Entity type:Organization
Organization Name:APPALACHIAN WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:OENBRINK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:828-785-1850
Mailing Address - Street 1:201 STONE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODFIN
Mailing Address - State:NC
Mailing Address - Zip Code:28804-8303
Mailing Address - Country:US
Mailing Address - Phone:828-785-1850
Mailing Address - Fax:828-785-1802
Practice Address - Street 1:201 STONE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:WOODFIN
Practice Address - State:NC
Practice Address - Zip Code:28804-8303
Practice Address - Country:US
Practice Address - Phone:828-785-1850
Practice Address - Fax:828-785-1802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01584207Q00000X
NC2009-01584207QA0401X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP83760Medicaid
NCNC2103AMedicare PIN