Healthcare Provider Details

I. General information

NPI: 1861992174
Provider Name (Legal Business Name): USA VEIN CLINICS OF WEST VIRGINIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 SUNCREST TOWNE CENTRE
MORGANTOWN WV
26505
US

IV. Provider business mailing address

304 WAINWRIGHT DR
NORTHBROOK IL
60062-1900
US

V. Phone/Fax

Practice location:
  • Phone: 304-381-3432
  • Fax:
Mailing address:
  • Phone: 224-318-0118
  • Fax: 224-235-4652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT MUSSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 330-242-3442