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	208100000X	Physical Medicine & Rehabilitation Physician
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician
3	208VP0000X	Pain Medicine Physician
4	225100000X	Physical Therapist
5	363A00000X	Physician Assistant
6	363L00000X	Nurse Practitioner
7	133V00000X	Registered Dietitian
8	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1992599419
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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1075 VAN VOORHIS RD STE 150
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26505-3588
Country	:	US
Telephone Number	:	304-598-6216
Fax Number	:	304-293-6963

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

Provider Enumeration Date	:	04/08/2025
Last Update Date	:	04/08/2025

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