Provider Demographics
NPI:1154675346
Name:ORTHOPEDICS-WVU SMC-OTPT HOSP
Entity Type:Organization
Organization Name:ORTHOPEDICS-WVU SMC-OTPT HOSP
Other - Org Name:UNIVERSITY HEALTH ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RCO COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:PILON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-285-7101
Mailing Address - Street 1:PO BOX 780
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-0780
Mailing Address - Country:US
Mailing Address - Phone:304-285-7100
Mailing Address - Fax:304-285-7126
Practice Address - Street 1:943 MAPLE DRIVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2812
Practice Address - Country:US
Practice Address - Phone:304-598-4830
Practice Address - Fax:304-598-4847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0011526000Medicaid
WV0011526000Medicaid