ELK RIVER MEDICAL ASSOCIATES, PA (NPI# 1093700338) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093700338 |
| Entity Type | Organization |
| Organization Name | ELK RIVER MEDICAL ASSOCIATES, PA |
| Other Organization Name | ELK RIVER INTERNAL MEDICINE |
| Practice Address |
150 Park Ave Banner Elk NC 28604-6604 |
| Mailing Address |
Po Box 1568 Banner Elk NC 28604-1568 |
| Practice Telephone | 8288985177 |
| Practice Fax Number | 8288988306 |
| Mailing Telephone | 8288985177 |
| Mailing Fax Number | 8288988306 |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. DAVID PAUL KIMMEL (PRESIDENT/STAFF PHYSICIAN) |
| Authorized Official Telephone | 8288985177 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
38891 | NC | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | GROUP RAILROAD MEDICARE | C14617 | 01 |
| NC | 890150B | 05 | |
| TN | 4404134 | 05 | |
| NC | NC BLUECROSS BLUESHIELD | 0150B | 01 |
| TN | TN BLUECROSS&TENNCARE | 112304 | 01 |
| Other Name | Type Code |
|---|---|
| Elk River Internal Medicine | Former Legal Business Name - Organization |
| Street Address |
150 PARK AVE |
| City | BANNER ELK |
| State | NC |
| Zip Code | 28604-6604 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073073953 | Charles A Cannon Jr Memorial Hospital, Inc. | Clinic/Center | 150 Park Ave, Banner Elk, NC 28604-6604 | 2019-03-25 |
| 1487891933 | Appalachian Regional Medical Associates | Internal Medicine | 150 Park Ave, Banner Elk, NC 28604-6604 | 2009-01-20 |
| 1053306092 | David Paul Kimmel | Internal Medicine | 150 Park Ave, Banner Elk, NC 28604-6604 | 2005-09-15 |
| 1699760959 | Alfred Douglas Earwood | Family Medicine | 150 Park Ave, Banner Elk, NC 28604-6604 | 2005-09-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184194755 | William H Burrow Dds Pllc Dba High Country Dental Associates | Clinic/Center | 2043 Tynecastle Highway, Banner Elk, NC 28604 | 2018-11-27 |
| 1699268953 | Barium Springs Home for Children | Community/Behavioral Health | 158 Grandfather Home Drive Bldg 2, Banner Elk, NC 28604 | 2018-06-12 |
| 1578973996 | Grandfather Home for Children, Inc. | Community Based Residential Treatment Facility, Mental Illness | 158 Grandfather Home Drive, Banner Elk, NC 28604 | 2014-05-07 |
| 1134417314 | Grandfather Home for Children, Inc. | Community Based Residential Treatment Facility, Mental Illness | 233 Grandfather Home Dr., Banner Elk, NC 28604 | 2011-07-21 |
| 1841598745 | Ivan Smith | Pharmacist | 4059 Nc Hwy 105, Rite Aid Pharmacy, Sugar Mountain, NC 28604 | 2011-03-02 |
| 1043515679 | Grandfather Home for Children, Incorporated | Community/Behavioral Health | 64 Grandfather Home Drive, Banner Elk, NC 28604 | 2011-01-12 |
| 1710133012 | Stephanie Knowles | Social Worker | 158 Grandfather Home for Children Way, Hickory Nut Gap Road, Banner Elk, NC 28604 | 2008-08-18 |
| 1235313909 | Dennis Robert Blair | Respiratory Therapist, Registered | 335 Leslie Ln, Banner Elk, NC 28604 | 2007-12-18 |
| 1780867291 | Robert Jones | Spec/Tech, Cardiovascular | 28 Wildcat Creek Lane, Banner Elk, NC 28604 | 2007-12-07 |
| 1730308172 | Erling L Fredrickson | Social Worker | 158 Grandfather Home Way, Hickory Nut Gap Rd., Banner Elk, NC 28604 | 2007-04-24 |
| Find all providers in zip 28604 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
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| 1891330056 | Veritas Collaborative Charlotte, LLC | Clinic/Center | 1900 Scott Ave Ste 101, Charlotte, NC 28203-6046 | 2019-11-12 |
| 1770135808 | American Family Care Fuquay Pllc | Clinic/Center | 1298 N Main St, Fuquay Varina, NC 27526-2615 | 2019-07-09 |
| 1508424029 | Shelly Renea Obasoluyi | Clinic/Center | 403 Atwell Dr, Fayetteville, NC 28314-0122 | 2019-05-30 |
| 1215593819 | Wilmington Health Pllc | Clinic/Center | 1811 Tiburon Dr, Wilmington, NC 28403-6254 | 2019-05-20 |
| 1003472804 | Loginclinics, Pllc | Clinic/Center | 1324 Reservoir View Ln, Wake Forest, NC 27587-1836 | 2019-05-16 |
| 1124586060 | Bethany Christian Services of Nc | Clinic/Center | 1110 Navaho Dr Ste 109, Raleigh, NC 27609-7352 | 2019-03-11 |
| 1548740038 | Hillsborough Community Urgent Care | Clinic/Center | 110 Boone Square St Ste 29a, Hillsborough, NC 27278-2665 | 2018-08-15 |
| 1679079537 | Carter Clinic, Pa | Clinic/Center | 260 1st Ave Nw Ste 215, Hickory, NC 28601-6161 | 2018-03-31 |
| Find all providers with the same taxonomy | ||||
| City | BANNER ELK |
| Zip Code | 28604 |
Please comment or provide details below to improve the information on ELK RIVER MEDICAL ASSOCIATES, PA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.