Provider Demographics
NPI:1861943334
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:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:LOVETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-264-4995
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:336-246-8163
Practice Address - Street 1:157 HEALTH SERVICES RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NC
Practice Address - Zip Code:28675-3000
Practice Address - Country:US
Practice Address - Phone:336-372-5641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPALACHIAN DISTRICT HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCD378OtherMEDICARE PTAN
NC1538270814OtherNPI FOR MEDICAL CLINIC