MEDICARE: WEST VIRGINIA UNIVERSITY MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician
2	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1023866845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST VIRGINIA UNIVERSITY MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 780
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26507-0780
Country	:	US
Telephone Number	:	304-285-7101
Fax Number	:	304-293-6963

Provider Business Practice Location Address
First Line	:	912 SOMERSET BLVD STE 101
Second Line	:
City	:	CHARLES TOWN
State	:	WV
Zip	:	25414-3954
Country	:	US
Telephone Number	:	304-725-2663
Fax Number	:	304-724-0053

Authorized Official
Title or Position	:	VP, FINANCE
Name	:	JUSTIN GIBSON
Credential	:
Telephone Number	:	304-598-4256

Provider Enumeration Date	:	05/07/2024
Last Update Date	:	05/07/2024

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Directions to “WEST VIRGINIA UNIVERSITY MEDICAL CORPORATION ” Practice Location

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