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General NPI Number Information
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NPI Number | 1659419653
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Entity Type | Organization
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Legal Business Name | BALI SURGICAL PRACTICE PLLC
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 400 COURT ST STE 203
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City | CHARLESTON
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State | WV
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Zip | 25301-1653
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Country | US
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Telephone | 304-346-2254
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Fax | 304-346-3184
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Provider Business Mailing Address
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Address Line | 400 COURT ST STE 203
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City | CHARLESTON
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State | WV
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Zip | 25301-1653
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Country | US
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Telephone | 304-346-2254
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Fax | 304-346-3184
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | VEDA AMBER EVANS
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Credential |
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Telephone | 304-346-2254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular 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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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