MEDICARE: CHARLESTON SURGICAL HOSPITAL HEALTHCARE GROUP, PLLC

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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1285131144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLESTON SURGICAL HOSPITAL HEALTHCARE GROUP, PLLC

Provider Business Mailing Address
First Line	:	1306 KANAWHA BLVD E
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25301-3000
Country	:	US
Telephone Number	:	304-343-4371
Fax Number	:

Provider Business Practice Location Address
First Line	:	1306 KANAWHA BLVD E
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25301-3000
Country	:	US
Telephone Number	:	304-343-4371
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CHRISTINA ARVON
Credential	:
Telephone Number	:	304-353-0303

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	08/11/2023

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