Provider Demographics
NPI:1144242249
Name:WYTHE MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:WYTHE MEDICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYOUNG
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-228-2191
Mailing Address - Street 1:342 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-1185
Mailing Address - Country:US
Mailing Address - Phone:276-228-2191
Mailing Address - Fax:276-228-2801
Practice Address - Street 1:342 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-1185
Practice Address - Country:US
Practice Address - Phone:276-228-2191
Practice Address - Fax:276-228-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101012583207Q00000X
207Q00000X
VA0101023290207VG0400X
VA0024098505363LF0000X
VA0024093951363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB05567Medicare UPIN
VAR95723Medicare UPIN
VAB10167Medicare UPIN
VAB08455Medicare UPIN
VAB07624Medicare UPIN
VAQ47518Medicare UPIN