Healthcare Provider Details

I. General information

NPI: 1063943678
Provider Name (Legal Business Name): MED SURG PHYSICIAN GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 06/28/2025
Certification Date: 06/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 HARPER RD STE ABC
BECKLEY WV
25801-2642
US

IV. Provider business mailing address

104 FLORIDA AVE
BECKLEY WV
25801-2408
US

V. Phone/Fax

Practice location:
  • Phone: 304-253-3000
  • Fax: 304-929-2038
Mailing address:
  • Phone: 304-673-4294
  • Fax: 304-255-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number21042
License Number StateWV

VIII. Authorized Official

Name: DR. OLU R SANGODEYI
Title or Position: OWNER, CEO
Credential: M. D.
Phone: 304-673-4294