| Organization Name: | ELK RIVER MEDICAL ASSOCIATES, PA |
| NPI Number: | 1093700338 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID PAUL KIMMEL (PRESIDENT/STAFF PHYSICIAN) |
| Mailing Address: | 150 Park Ave Banner Elk |
| State: | NC US |
| Postal Code: | 286046604 |
| Phone Number: | 8288985177 |
| Fax Number: | 8288988306 |
| NPI Enumeration Date: | 09/13/2005 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | 38891 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |