Provider Demographics
NPI:1336632660
Name:MOUNTAINEER CARDIOLOGY PLLC
Entity Type:Organization
Organization Name:MOUNTAINEER CARDIOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:681-205-8610
Mailing Address - Street 1:2345 CHESTERFIELD AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1064
Mailing Address - Country:US
Mailing Address - Phone:681-205-8610
Mailing Address - Fax:681-205-8615
Practice Address - Street 1:2345 CHESTERFIELD AVE STE 302
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1064
Practice Address - Country:US
Practice Address - Phone:681-205-8610
Practice Address - Fax:681-205-8615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty