Healthcare Provider Details

I. General information

NPI: 1518303288
Provider Name (Legal Business Name): WMC PHYSICIAN PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 STEUBENVILLE PIKE
BURGETTSTOWN PA
15021-8539
US

IV. Provider business mailing address

651 COLLIERS WAY # 300
WEIRTON WV
26062-5053
US

V. Phone/Fax

Practice location:
  • Phone: 304-797-6557
  • Fax: 304-797-6306
Mailing address:
  • Phone: 304-797-6557
  • Fax: 304-797-6306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA LEE MCKEEN
Title or Position: PROVIDER SUPPORT AND CREDENTIALING
Credential:
Phone: 304-797-6404