Healthcare Provider Details

I. General information

NPI: 1669708442
Provider Name (Legal Business Name): APOGEE MEDICAL GROUP, WEST VIRGINIA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 HOSPITAL DR
LOGAN WV
25601-3452
US

IV. Provider business mailing address

PO BOX 708760
SANDY UT
84070-8760
US

V. Phone/Fax

Practice location:
  • Phone: 304-831-1643
  • Fax:
Mailing address:
  • Phone: 972-269-1897
  • Fax: 801-352-7976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KEVIN GREGORY
Title or Position: CIO
Credential:
Phone: 602-778-3600