Provider Demographics
| NPI: | 1083373997 |
|---|---|
| Name: | MED SURG PHYSICIAN GROUP, INC. |
| Entity Type: | Organization |
| Organization Name: | MED SURG PHYSICIAN GROUP, INC. |
| Other - Org Name: | ELENA BEHAVIORAL HEALTH |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | OFFICE MANAGER |
| Authorized Official - Prefix: | MS |
| Authorized Official - First Name: | AMBER |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | MOORE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 304-253-3000 |
| Mailing Address - Street 1: | 1902 HARPER RD STE ABC |
| Mailing Address - Street 2: | |
| Mailing Address - City: | BECKLEY |
| Mailing Address - State: | WV |
| Mailing Address - Zip Code: | 25801-2642 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 304-253-3000 |
| Mailing Address - Fax: | 304-929-2038 |
| Practice Address - Street 1: | 379 STANAFORD RD STE 200 |
| Practice Address - Street 2: | |
| Practice Address - City: | BECKLEY |
| Practice Address - State: | WV |
| Practice Address - Zip Code: | 25801-3141 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 304-253-3000 |
| Practice Address - Fax: | 304-929-2038 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2021-12-08 |
| Last Update Date: | 2023-10-12 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
| No | 261QR0800X | Ambulatory Health Care Facilities | Clinic/Center | Recovery Care | |
| No | 276400000X | Hospital Units | Rehabilitation, Substance Use Disorder Unit | ||
| No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | ||
| No | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | ||
| No | 3245S0500X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children | |
| No | 343900000X | Transportation Services | Non-emergency Medical Transport (VAN) | Group - Multi-Specialty |
