Healthcare Provider Details

I. General information

NPI: 1750513032
Provider Name (Legal Business Name): THE CIRCULATORY CENTER OF WEST VIRGINIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 CHURCHILL HUBBARD RD
YOUNGSTOWN OH
44505-1375
US

IV. Provider business mailing address

1111 VAN VOORHIS ROAD 2ND FLOOR
MORGANTOWN WV
26505
US

V. Phone/Fax

Practice location:
  • Phone: 330-759-6760
  • Fax: 330-759-6755
Mailing address:
  • Phone: 800-526-3082
  • Fax: 330-759-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LOUIS M CERTO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 330-759-6750