Provider Demographics
NPI:1285814640
Name:BECKLEY VASCULAR ASSOCIATES PLLC
Entity Type:Organization
Organization Name:BECKLEY VASCULAR ASSOCIATES PLLC
Other - Org Name:RIVER REGION SURGICAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WHYTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-250-0382
Mailing Address - Street 1:122 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2608
Mailing Address - Country:US
Mailing Address - Phone:304-250-0382
Mailing Address - Fax:304-250-0383
Practice Address - Street 1:122 GEORGE ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2608
Practice Address - Country:US
Practice Address - Phone:304-250-0382
Practice Address - Fax:304-250-0383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV228522086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVBE9373011Medicare PIN