Provider Demographics
NPI:1659391472
Name:TYGART VALLEY ORTHOPEDICS AND SPORTS MEDICINE, INC.
Entity Type:Organization
Organization Name:TYGART VALLEY ORTHOPEDICS AND SPORTS MEDICINE, INC.
Other - Org Name:TYGART VALLEY ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EDMOND
Authorized Official - Last Name:TOPPING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-637-4509
Mailing Address - Street 1:PO BOX 848220
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-8220
Mailing Address - Country:US
Mailing Address - Phone:304-637-4509
Mailing Address - Fax:304-637-5319
Practice Address - Street 1:1502 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3327
Practice Address - Country:US
Practice Address - Phone:304-637-4509
Practice Address - Fax:304-637-5319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5110270001OtherMEDICARE DME
WV001710883OtherBC/BS ID NUMBER
WV4000084000OtherMEDICAID ID NUMBER
WV=========OtherTAX ID
WV5110270001OtherMEDICARE DME
WV5110270001Medicare NSC