Healthcare Provider Details

I. General information

NPI: 1619343951
Provider Name (Legal Business Name): JOHN WOLEN SURGICAL ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 MOUNT WOOD RD
WHEELING WV
26003-2632
US

IV. Provider business mailing address

109 MOUNT WOOD RD
WHEELING WV
26003-2632
US

V. Phone/Fax

Practice location:
  • Phone: 304-233-2455
  • Fax: 304-233-6073
Mailing address:
  • Phone: 304-233-2455
  • Fax: 304-233-6073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number22703
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number22703
License Number StateWV

VIII. Authorized Official

Name: MR. JOHN JASON WOLEN
Title or Position: OWNER
Credential: MD
Phone: 304-233-2455