Provider Demographics
NPI:1609804251
Name:WESTERN VIRGINIA HMA PHYSICIAN MANAGEMENT INC
Entity Type:Organization
Organization Name:WESTERN VIRGINIA HMA PHYSICIAN MANAGEMENT INC
Other - Org Name:WISE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-679-5880
Mailing Address - Street 1:PO BOX 707
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-0707
Mailing Address - Country:US
Mailing Address - Phone:276-679-5880
Mailing Address - Fax:276-679-6243
Practice Address - Street 1:340 ANDERSON HOLLOW RD
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1100
Practice Address - Country:US
Practice Address - Phone:276-679-5880
Practice Address - Fax:276-679-6243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C09465Medicare ID - Type Unspecified