Healthcare Provider Details

I. General information

NPI: 1629481098
Provider Name (Legal Business Name): BECKLEY PHYSICAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 YELLOW WOOD WAY
BECKLEY WV
25801-7126
US

IV. Provider business mailing address

9 YELLOW WOOD WAY
BECKLEY WV
25801-7126
US

V. Phone/Fax

Practice location:
  • Phone: 304-250-6047
  • Fax: 304-250-6048
Mailing address:
  • Phone: 304-250-6047
  • Fax: 304-250-6048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVE NATHANSON
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 304-250-6047