Provider Demographics
NPI:1922506161
Name:WEST VIRGINIA VASCULAR INSTITUTE PLLC
Entity Type:Organization
Organization Name:WEST VIRGINIA VASCULAR INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:OYE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-255-3601
Mailing Address - Street 1:250 STANAFORD RD STE 202
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3140
Mailing Address - Country:US
Mailing Address - Phone:304-255-3601
Mailing Address - Fax:304-255-3340
Practice Address - Street 1:250 STANAFORD RD STE 202
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:304-255-3340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1595332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001964Medicaid
WV001726273OtherHIGHMARK BLUE CROSS BLUE SHIELD