MOUNTAIN STATE ORTHOPEDICS & SPORTS MEDICINE (NPI# 1285821561) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285821561 |
| Entity Type | Organization |
| Organization Name | MOUNTAIN STATE ORTHOPEDICS & SPORTS MEDICINE |
| Practice Address |
400 Fairview Heights Rd Ste. 301 Summersville WV 26651-9308 |
| Mailing Address |
Po Box 927 Summersville WV 26651-0927 |
| Practice Telephone | 3048807988 |
| Practice Fax Number | 3048807987 |
| Mailing Telephone | 3048807988 |
| Mailing Fax Number | 3048807987 |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2008-12-29 |
| Authorized Official Name | DR. WILLIAM R. CARSON (PRESIDENT) |
| Authorized Official Telephone | 3048807988 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 204C00000X | Neuromusculoskeletal Medicine, Sports Medicine | WV18114 | WV | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WV | RAILROAD MEDICARE | 200025785 | 01 |
| WV | MEDICARE PROVIDER NUMBER | 9286011 | 01 |
| WV | 0098219000 | 05 |
| Street Address |
400 FAIRVIEW HEIGHTS RD STE. 301 |
| City | SUMMERSVILLE |
| State | WV |
| Zip Code | 26651-9308 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760481014 | Jonathan B Dale | Emergency Medicine | 400 Fairview Heights Rd, Summersville, WV 26651-9308 | 2005-07-19 |
| 1154929388 | Rachel Davis | Pharmacist | 400 Fairview Heights Rd, Summersville, WV 26651-9308 | 2020-10-10 |
| 1326655838 | Georgiana Lane Jarvis | Pharmacist | 400 Fairview Heights Rd, Summersville, WV 26651 | 2020-09-29 |
| 1417415324 | West Virginia Health Care Cooperative Inc | Urology | 400 Fairview Heights Rd, Summersville, WV 26651-9308 | 2019-03-10 |
| 1407314313 | West Virginia Health Care Cooperative Inc | Pharmacy | 400 Fairview Heights Rd, Summersville, WV 26651-9308 | 2019-03-10 |
| 1194283192 | West Virginia Health Care Cooperative Inc | Skilled Nursing Facility | 400 Fairview Heights Rd, Summersville, WV 26651-9308 | 2019-03-08 |
| 1548728553 | West Virginia Health Care Cooperative Inc | Clinic/Center | 400 Fairview Heights Rd, Summersville, WV 26651-9308 | 2019-03-08 |
| 1043778319 | West Virginia Health Care Cooperative Inc | Clinical Medical Laboratory | 400 Fairview Heights Rd, Summersville, WV 26651-9308 | 2019-03-06 |
| 1336692441 | Amy Mann | Nurse Practitioner | 400 Fairview Heights Rd, Summersville, WV 26651-9308 | 2016-07-26 |
| 1124470778 | Nicholas Emergency Group, Pllc | Physician Assistant | 400 Fairview Heights Rd, Summersville, WV 26651-9308 | 2016-07-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568061588 | Marcy Nicole Myerholtz | Pharmacist | 700 Northside Drive, Cvs Pharmacy, Summersville, WV 26651 | 2020-10-21 |
| 1104425396 | Travis Giles | Physical Therapy Assistant | 2129 Canvas Nettie Rd, Summersville, WV 26651 | 2020-10-20 |
| 1043837586 | Clorinda L Workman | Registered Nurse | 221 Bright of America Road, Summersville, WV 26651 | 2020-07-01 |
| 1669947222 | Camden On Gauley Medical Center, Inc. | Clinic/Center | 70 Grade School Lane, Summersville, WV 26651 | 2018-10-10 |
| 1902310451 | Carolyn Maxwell Evans | Technician | 554 Ritchie Farm Road, Summersville, WV 26651 | 2017-11-20 |
| 1568904829 | Nicholas Community Action Partnership, Inc | Case Management | 1205 Broad Street, Summersville, WV 26651 | 2016-11-17 |
| 1831645647 | Rachel Hendricks | Psychologist | 400 Old Main Drive, Nicholas County Schools, Summersville, WV 26651 | 2016-08-31 |
| 1831592542 | Vass Vocational Services, In. | Case Manager/Care Coordinator | 304 Bibb Lane, Summersville, WV 26651 | 2014-10-08 |
| 1417229329 | Professional Medical Ultrasonics Inc. | Clinic/Center | 4089 Webster Rd Suite 5, Summersville, WV 26651 | 2012-02-08 |
| 1437426459 | All Med, LLC | Durable Medical Equipment & Medical Supplies | 602 Appalachian Dr., Summersville, WV 26651 | 2011-11-18 |
| Find all providers in zip 26651 | ||||
| Taxonomy Code | 204C00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Neuromusculoskeletal Medicine, Sports Medicine |
| Definition to come. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851445225 | William R Carson | Neuromusculoskeletal Medicine, Sports Medicine | 400 Fairview Heights Rd, Ste 301, Summersville, WV 26651-9308 | 2007-01-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053517011 | Lisa Ann Waugh | Neuromusculoskeletal Medicine, Sports Medicine | 1109 Jefferson Rd, S Charleston, WV 25309-9780 | 2007-06-26 |
| 1083836654 | Almost Heaven Therapeutic Massage | Neuromusculoskeletal Medicine, Sports Medicine | 1436 Greenbrier Street, Charleston, WV 25311 | 2007-05-03 |
| 1780713438 | Debra Lynn Price | Neuromusculoskeletal Medicine, Sports Medicine | 1436 Greenbrier St, Charleston, WV 25311-1006 | 2007-03-05 |
| 1245367929 | Joby Joseph,md Inc | Neuromusculoskeletal Medicine, Sports Medicine | 888 Oakwood Rd, Suite 210, Charleston, WV 25314-2000 | 2007-02-28 |
| 1649368291 | Sportscare Medical Associates, Inc. | Neuromusculoskeletal Medicine, Sports Medicine | 320 Lynda Ct, Huntington, WV 25703 | 2006-10-10 |
| 1295799245 | Joby Joseph | Neuromusculoskeletal Medicine, Sports Medicine | 888 Oakwood Road, Suite 210, Charleston, WV 25314-2070 | 2006-04-14 |
| 1134120173 | John C Sharp | Neuromusculoskeletal Medicine, Sports Medicine | 105 Duncan Rd, Marlinton, WV 24954-0320 | 2005-08-01 |
| City | SUMMERSVILLE |
| Zip Code | 26651 |
Please comment or provide details below to improve the information on MOUNTAIN STATE ORTHOPEDICS & SPORTS MEDICINE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.