Provider Demographics
NPI:1093898439
Name:HEISKELL KING BURNS & TALLMAN SURGICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:HEISKELL KING BURNS & TALLMAN SURGICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:HEISKELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-598-2200
Mailing Address - Street 1:600 SUNCREST TOWNE CENTRE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1872
Mailing Address - Country:US
Mailing Address - Phone:304-598-2200
Mailing Address - Fax:304-599-2674
Practice Address - Street 1:600 SUNCREST TOWNE CENTRE
Practice Address - Street 2:SUITE 310
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1872
Practice Address - Country:US
Practice Address - Phone:304-598-2200
Practice Address - Fax:304-599-2674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-21
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000865700Medicaid
WV9244291Medicare ID - Type Unspecified