Provider Demographics
NPI:1548331960
Name:APPALACHIAN PRIMARY CARE
Entity type:Organization
Organization Name:APPALACHIAN PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:SCHOWENGERDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-454-3217
Mailing Address - Street 1:1246 ASHLAND AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2861
Mailing Address - Country:US
Mailing Address - Phone:740-454-3217
Mailing Address - Fax:740-454-8134
Practice Address - Street 1:1246 ASHLAND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2861
Practice Address - Country:US
Practice Address - Phone:740-454-3217
Practice Address - Fax:740-454-8134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35025730305S00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered305S00000XManaged Care OrganizationsPoint of Service
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH497345988004OtherMEDICAL MUTUAL OF OHIO
OH000000349823OtherANTHEM
OH0223887Medicaid
OH0223887Medicaid
OHA80832Medicare UPIN