Healthcare Provider Details

I. General information

NPI: 1093898439
Provider Name (Legal Business Name): HEISKELL KING BURNS & TALLMAN SURGICAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SUNCREST TOWNE CENTRE SUITE 310
MORGANTOWN WV
26505-1872
US

IV. Provider business mailing address

600 SUNCREST TOWNE CENTRE SUITE 310
MORGANTOWN WV
26505-1872
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-2200
  • Fax: 304-599-2674
Mailing address:
  • Phone: 304-598-2200
  • Fax: 304-599-2674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES ANDREW HEISKELL
Title or Position: PRESIDENT
Credential: MD
Phone: 304-598-2200