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MOUNTAIN STATE ENT & FACIAL PLASTIC SURGERY INC NPI 1982604997


NPI Information

NPI: 1982604997
Provider Name: MOUNTAIN STATE ENT & FACIAL PLASTIC SURGERY, INC

Other Name: MOUNTAIN STATE ENT AND FACIAL PLASTIC SURGERY

Classification: Clinic/Center - 261QM2500X
Entity Type: Organization

Specialization: Medical Specialty

CLIA Number: 51D1018891

Address:
78 BROOKSHIRE LN
BECKLEY, WV
ZIP 25801
Phone: (304) 255-2341
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MOUNTAIN STATE ENT & FACIAL PLASTIC SURGERY, INC is a medical specialty clinic center in Beckley, WV. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). MOUNTAIN STATE ENT & FACIAL PLASTIC SURGERY, INC NPI is 1982604997. The provider is registered as an organization entity type.
The provider Other Name Is Mountain State Ent And Facial Plastic Surgery.

The provider's business location address is:

78 BROOKSHIRE LN
BECKLEY, WV
ZIP 25801-765
Phone: (304) 255-2341
Fax: (304) 255-2343

The provider's authorized official is Albert James Paine .
The authorized official title is Owner; President and has the following contact phone number (304) 255-2341.

The CLIA number assigned to this NPI record is 51D1018891 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/1/2005 and was last updated on 3/29/2024.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QM2500XClinic/CenterMedical Specialty006769WEST VIRGINIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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