Healthcare Provider Details

I. General information

NPI: 1710273313
Provider Name (Legal Business Name): WEST VIRGINIA SURGICAL INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 STANAFORD RD
BECKLEY WV
25801-3140
US

IV. Provider business mailing address

PO BOX 86
DANIELS WV
25832-0086
US

V. Phone/Fax

Practice location:
  • Phone: 304-255-3601
  • Fax: 304-255-3604
Mailing address:
  • Phone: 304-255-3601
  • Fax: 304-255-3604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberWV21557
License Number StateWV

VIII. Authorized Official

Name: MRS. EUPHEMIA OYE
Title or Position: OWNER
Credential:
Phone: 304-255-3601