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General NPI Number Information
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NPI Number | 1831841675
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Entity Type | Organization
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Legal Business Name | MOUNTAIN STATE ORTHOPEDICS AND SPORTS MEDICINE
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 03/13/2024
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Provider Practice Location Address
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Address Line | 4089W WEBSTER RD
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City | SUMMERSVILLE
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State | WV
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Zip | 26651-9682
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Country | US
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Telephone | 304-900-2589
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Fax | 800-397-1586
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Provider Business Mailing Address
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Address Line | 4089 WEBSTER RD
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City | SUMMERSVILLE
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State | WV
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Zip | 26651-7200
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Country | US
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Telephone | 304-900-2589
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM R CARSON
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Credential | M.D.
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Telephone | 304-900-2589
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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 |
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