Healthcare Provider Details

I. General information

NPI: 1023531449
Provider Name (Legal Business Name): KYLE GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 S OAKWOOD AVE
BECKLEY WV
25801-5977
US

IV. Provider business mailing address

PO BOX 5336
BECKLEY WV
25801-7504
US

V. Phone/Fax

Practice location:
  • Phone: 304-860-0360
  • Fax:
Mailing address:
  • Phone: 304-860-0360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number12360
License Number StateWV

VIII. Authorized Official

Name: JAMES M. KYLE
Title or Position: OWNER/CEO
Credential: MD
Phone: 304-860-0360