Healthcare Provider Details

I. General information

NPI: 1184349987
Provider Name (Legal Business Name): APPALACHIAN PRIMARY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 HAYWOOD PARK DR
CLYDE NC
28721-4405
US

IV. Provider business mailing address

107 HAYWOOD PARK DR
CLYDE NC
28721-4405
US

V. Phone/Fax

Practice location:
  • Phone: 828-237-8001
  • Fax: 828-237-8002
Mailing address:
  • Phone: 828-237-8001
  • Fax: 828-237-8002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: TRAVIS M HECKER
Title or Position: OWNER/CEO
Credential: MD
Phone: 828-237-8001