Organization Name: | APPA LLC |
NPI Number: | 1578939542 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DOUGLAS LILLIFIELD (OWNER) |
Mailing Address: | 3170 Appalachian Hwy Jacksboro |
State: | TN US |
Postal Code: | 377575500 |
Phone Number: | 4048624866 |
Fax Number: | |
NPI Enumeration Date: | 08/13/2015 |
NPI Last Update Date: | 08/13/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 174 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |