Provider Demographics
NPI:1649639048
Name:MOUNTAIN STATE ENT & FACIAL PLASTIC SURGERY, INC
Entity type:Organization
Organization Name:MOUNTAIN STATE ENT & FACIAL PLASTIC SURGERY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER; PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PAINE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:304-255-2341
Mailing Address - Street 1:78 BROOKSHIRE
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801
Mailing Address - Country:US
Mailing Address - Phone:304-255-0330
Mailing Address - Fax:
Practice Address - Street 1:78 BROOKSHIRE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801
Practice Address - Country:US
Practice Address - Phone:304-255-0330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNTAIN STATE ENT & FACIAL PLASTIC SURGERY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-15
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty