Provider Demographics
NPI:1871040626
Name:WEST VIRGINIA ORTHOPEDIC TRAUMA INC
Entity Type:Organization
Organization Name:WEST VIRGINIA ORTHOPEDIC TRAUMA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TABIT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-400-9420
Mailing Address - Street 1:1404 ROBERT C. BYRD DR
Mailing Address - Street 2:SUITE 216
Mailing Address - City:CRAB ORCHARD
Mailing Address - State:WV
Mailing Address - Zip Code:25827-9440
Mailing Address - Country:US
Mailing Address - Phone:304-410-0061
Mailing Address - Fax:304-410-0574
Practice Address - Street 1:201 WOODCREST DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3735
Practice Address - Country:US
Practice Address - Phone:304-410-0061
Practice Address - Fax:304-410-0574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2621207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Single Specialty