Provider Demographics
NPI:1639477284
Name:S VYAS MD INC
Entity type:Organization
Organization Name:S VYAS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUBHASH
Authorized Official - Middle Name:A
Authorized Official - Last Name:VYAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-235-0222
Mailing Address - Street 1:22 1/2 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-3506
Mailing Address - Country:US
Mailing Address - Phone:304-235-0222
Mailing Address - Fax:304-235-4343
Practice Address - Street 1:22 1/2 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3506
Practice Address - Country:US
Practice Address - Phone:304-235-0222
Practice Address - Fax:304-235-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0130944000Medicaid
WV0439324Medicare PIN
WV0130944000Medicaid