MEDICARE: DR. GEOFFREY R COUSINS MD

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	WV21957	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	001766919	OTHER	WV	BCBS

General Provider Information

NPI Number	:	1750379376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEOFFREY R COUSINS MD

Provider Business Mailing Address
First Line	:	PO BOX 88
Second Line	:	200 POCAHONTAS TRAIL
City	:	WHITE SULPHUR SPRINGS
State	:	WV
Zip	:	24986-0088
Country	:	US
Telephone Number	:	304-536-5030
Fax Number	:	304-536-5031

Provider Business Practice Location Address
First Line	:	2828 1ST AVE
Second Line	:	SUITE 200
City	:	HUNTINGTON
State	:	WV
Zip	:	25702-1236
Country	:	US
Telephone Number	:	304-399-7530
Fax Number	:	304-399-7532

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	04/20/2022

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