Healthcare Provider Details

I. General information

NPI: 1659552958
Provider Name (Legal Business Name): STEVE SCOTT MELEK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 MAIN AVE PROFESSIONAL BUILDING
LOGAN WV
25601-3332
US

IV. Provider business mailing address

PO BOX 1350
CHAPMANVILLE WV
25508-1350
US

V. Phone/Fax

Practice location:
  • Phone: 304-752-3338
  • Fax: 304-752-0194
Mailing address:
  • Phone: 304-752-3338
  • Fax: 304-752-0194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number269
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number269
License Number StateWV

VIII. Authorized Official

Name: STEVE SCOTT MELEK
Title or Position: OWNER
Credential:
Phone: 304-752-3338