Provider Demographics
NPI:1942251848
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:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:PE
Authorized Official - Last Name:OYE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
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:
Practice Address - Street 1:250 STANAFORD RD
Practice Address - Street 2:STE203
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
WVWV15952086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0005093623OtherAETNA
WV001726273OtherBCBS
WV3810001964Medicaid
WVDD3621OtherRR MCARE
WVDD3621OtherRR MCARE
WVG20061Medicare UPIN