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General NPI Number Information
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NPI Number | 1386728202
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Entity Type | Organization
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Legal Business Name | GREAT TEAYS MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3703 TEAYS VALLEY RD
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City | HURRICANE
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State | WV
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Zip | 25526-9645
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Country | US
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Telephone | 304-760-9250
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Fax | 304-760-9290
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Provider Business Mailing Address
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Address Line | 3703 TEAYS VALLEY RD
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City | HURRICANE
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State | WV
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Zip | 25526-9645
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Country | US
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Telephone | 304-760-9250
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Fax | 304-760-9290
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | JULIE D RAY
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Credential |
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Telephone | 304-760-9250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State | WV
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