Provider Demographics
NPI:1760473425
Name:BECKLEY SURGERY CENTER, INC
Entity Type:Organization
Organization Name:BECKLEY SURGERY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAINE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:304-255-2724
Mailing Address - Street 1:84 BROOKSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-6765
Mailing Address - Country:US
Mailing Address - Phone:304-255-2724
Mailing Address - Fax:304-255-3691
Practice Address - Street 1:84 BROOKSHIRE LN
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6765
Practice Address - Country:US
Practice Address - Phone:304-255-2724
Practice Address - Fax:304-255-3691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1351261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000394182OtherBCBS PAY TO ID
WV5080008000Medicaid
WV490004321OtherRAILROAD MEDICARE NUMBER
WV1047629OtherWORKERS COMP PROV #
WV1047629OtherWORKERS COMP PROV #