Provider Demographics
NPI:1265481220
Name:BECKLEY AREA SURGICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:BECKLEY AREA SURGICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:KILLMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-256-0770
Mailing Address - Street 1:230 GEORGE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2620
Mailing Address - Country:US
Mailing Address - Phone:304-256-0770
Mailing Address - Fax:304-256-0772
Practice Address - Street 1:230 GEORGE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2620
Practice Address - Country:US
Practice Address - Phone:304-256-0770
Practice Address - Fax:304-256-0772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001711081OtherBCBS
WVBE9313301Medicare PIN