Provider Demographics
NPI:1912044389
Name:CHARLESTON HEART SPECIALISTS PLLC
Entity Type:Organization
Organization Name:CHARLESTON HEART SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:LILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-346-2284
Mailing Address - Street 1:2345 CHESTERFIELD AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1062
Mailing Address - Country:US
Mailing Address - Phone:304-346-2284
Mailing Address - Fax:304-345-7745
Practice Address - Street 1:2345 CHESTERFIELD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1062
Practice Address - Country:US
Practice Address - Phone:304-346-2284
Practice Address - Fax:304-345-7745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0011167000Medicaid
WV9299782Medicare ID - Type UnspecifiedCHAPMANVILLE GROUP
WV9299783Medicare ID - Type UnspecifiedIYER LEE GROUP
WV9299784Medicare ID - Type UnspecifiedIMAGING GROUP
WV9299781Medicare ID - Type UnspecifiedBASU MIAN NARA GROUP
WV9299785Medicare ID - Type UnspecifiedMIAN WILLIAMSON