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
1	363A00000X	Physician Assistant
2	207RI0011X	Interventional Cardiology Physician
3	207RE0101X	Endocrinology, Diabetes & Metabolism Physician
4	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1174372056
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	:	650 CEDAR CREEK GRADE STE 100
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-6453
Country	:	US
Telephone Number	:	540-535-0000
Fax Number	:	540-535-0032

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

Provider Enumeration Date	:	05/14/2024
Last Update Date	:	05/14/2024

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Directions to “WEST VIRGINIA UNIVERSITY MEDICAL CORPORATION ” Practice Location

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