Basic Information
| Provider Information | |||||||||
| NPI: | 1770750341 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | APPALACHIAN MEDICAL SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT AT 960339 | ||||||||
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| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731960001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8884472450 | ||||||||
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| Practice Location | |||||||||
| Address1: | 886 HIGHWAY 411 N | ||||||||
| Address2: | |||||||||
| City: | ETOWAH | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373311912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232633600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2008 | ||||||||
| LastUpdateDate: | 07/21/2010 | ||||||||
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| AuthorizedOfficialLastName: | WINDER | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4232633600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | TN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1506779 | 05 | TN | MEDICAID | 4185158 | 01 | TN | BCBS OF TN | OTHER | DN8699 | 01 | TN | RAILROAD MEDICARE | OTHER |