=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013984160
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BONE AND JOINT SURGEONS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2006
-----------------------------------------------------
Last Update Date | 12/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 TRACY WAY
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-343-4583
-----------------------------------------------------
Fax | 304-343-9207
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 TRACY WAY
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-343-4583
-----------------------------------------------------
Fax | 304-343-9207
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. MARK D. NELSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 304-720-9640
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------