Healthcare Provider Details

I. General information

NPI: 1831545904
Provider Name (Legal Business Name): MGH SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MON HEALTH MEDICAL PARK DRIVE SUITE 2200
MORGANTOWN WV
26505-3494
US

IV. Provider business mailing address

2000 MON HEALTH MEDICAL PARK DRIVE SUITE 2200
MORGANTOWN WV
26505-3494
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-1200
  • Fax:
Mailing address:
  • Phone: 304-598-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DARRYL DUNCAN
Title or Position: CEO MON GEN HOSP
Credential:
Phone: 304-598-1200