Healthcare Provider Details

I. General information

NPI: 1932563046
Provider Name (Legal Business Name): WMC PHYSICIAN PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 JOHNSON RD STE 101
STEUBENVILLE OH
43952-2356
US

IV. Provider business mailing address

651 COLLIERS WAY STE 300
WEIRTON WV
26062-5058
US

V. Phone/Fax

Practice location:
  • Phone: 740-275-4645
  • Fax:
Mailing address:
  • Phone: 304-797-6557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY SUE SUE WINLAND
Title or Position: AR COORDINATOR
Credential:
Phone: 304-797-6557