Provider Demographics
NPI:1295756559
Name:UPSHUR MEDICAL MANAGEMENT SERVICES
Entity type:Organization
Organization Name:UPSHUR MEDICAL MANAGEMENT SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-473-2118
Mailing Address - Street 1:10 AMALIA DR
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-2271
Mailing Address - Country:US
Mailing Address - Phone:304-473-2200
Mailing Address - Fax:304-473-2057
Practice Address - Street 1:10 AMALIA DR
Practice Address - Street 2:SUITE B-1
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2271
Practice Address - Country:US
Practice Address - Phone:304-473-2200
Practice Address - Fax:304-473-2057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0009185000Medicaid
WV0009185000Medicaid