Provider Demographics
NPI:1740264316
Name:PLEASANT VALLEY ORTHOPEDICS
Entity type:Organization
Organization Name:PLEASANT VALLEY ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCCLEARY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:304-675-5275
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550
Mailing Address - Country:US
Mailing Address - Phone:304-675-5275
Mailing Address - Fax:304-675-4878
Practice Address - Street 1:2520 VALLEY DR
Practice Address - Street 2:SUITE 211
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550
Practice Address - Country:US
Practice Address - Phone:304-675-5275
Practice Address - Fax:304-675-4878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1858208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2587599Medicaid
WV3170001873Medicaid
WV3170001873Medicaid
OH2587599Medicaid