Provider Demographics
NPI:1336661396
Name:MOUNTAINEER CARDIOVASCULAR CARE INC
Entity Type:Organization
Organization Name:MOUNTAINEER CARDIOVASCULAR CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GETACHEW
Authorized Official - Middle Name:T
Authorized Official - Last Name:ZELEKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-253-6227
Mailing Address - Street 1:1830 HARPER RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3366
Mailing Address - Country:US
Mailing Address - Phone:304-253-6227
Mailing Address - Fax:304-253-6411
Practice Address - Street 1:1830 HARPER RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3366
Practice Address - Country:US
Practice Address - Phone:304-253-6227
Practice Address - Fax:304-253-6411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty