=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497763148
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APPALACHIAN CENTER FOR OBESITY SURGERY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARROLL & TATE STS. SUITE 4
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-883-8026
-----------------------------------------------------
Fax | 276-883-8027
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2557
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24266-2557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-883-8026
-----------------------------------------------------
Fax | 276-883-8027
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANDREW PHILLIP KRAMER
-----------------------------------------------------
Credential | D.O. FACOS
-----------------------------------------------------
Telephone | 276-883-8026
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------