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General NPI Number Information
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NPI Number | 1205596665
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Entity Type | Organization
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Legal Business Name | ST. MARY'S MEDICAL MANAGEMENT, LLC
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Dates
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Enumeration Date | 12/28/2021
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 2828 1ST AVE STE 400
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City | HUNTINGTON
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State | WV
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Zip | 25702-1236
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Country | US
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Telephone | 304-525-6905
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Fax | 304-525-0747
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Provider Business Mailing Address
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Address Line | 3075 US ROUTE 60
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City | HUNTINGTON
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State | WV
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Zip | 25705-8859
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Country | US
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Telephone | 304-528-4600
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MARK A MORGAN
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Credential |
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Telephone | 304-528-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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