Provider Demographics
NPI:1265550826
Name:BECKLEY PODIATRY ASSOCIATES INC
Entity type:Organization
Organization Name:BECKLEY PODIATRY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:II
Authorized Official - Credentials:DPM
Authorized Official - Phone:304-253-3372
Mailing Address - Street 1:100 NORTH HEIGHTS DRIVE
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801
Mailing Address - Country:US
Mailing Address - Phone:304-253-3372
Mailing Address - Fax:304-253-6685
Practice Address - Street 1:100 NORTH HEIGHTS DRIVE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801
Practice Address - Country:US
Practice Address - Phone:304-253-3372
Practice Address - Fax:304-253-6685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WICL8163OtherMETRAHEALTH MEDICARE
WV0009372000Medicaid
0694037OtherUNITED MINE WORKERS H & W
WV0009372000Medicaid