Provider Demographics
NPI:1710273313
Name:WEST VIRGINIA SURGICAL INSTITUTE
Entity Type:Organization
Organization Name:WEST VIRGINIA SURGICAL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EUPHEMIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-255-3601
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:DANIELS
Mailing Address - State:WV
Mailing Address - Zip Code:25832-0086
Mailing Address - Country:US
Mailing Address - Phone:304-255-3601
Mailing Address - Fax:304-255-3604
Practice Address - Street 1:250 STANAFORD RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3140
Practice Address - Country:US
Practice Address - Phone:304-255-3601
Practice Address - Fax:304-255-3604
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST VIRGINIA VASCULAR INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-22
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV21557208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty