MED SURG PHYSICIAN GROUP, INC. (NPI# 1063943678) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063943678 |
| Entity Type | Organization |
| Organization Name | MED SURG PHYSICIAN GROUP, INC. |
| Practice Address |
379 Stanaford Rd Beckley WV 25801-3141 |
| Mailing Address |
104 Florida Ave Beckley WV 25801-2408 |
| Practice Telephone | 3042533000 |
| Practice Fax Number | 3042557884 |
| Mailing Telephone | 3046734294 |
| Mailing Fax Number | 3042557884 |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2017-03-27 |
| Authorized Official Name | DR. OLU R SANGODEYI (OWNER, CEO) |
| Authorized Official Telephone | 3046734294 |
| Authorized Official Credential | M. D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 21042 | WV | Other Service Providers |
| Street Address |
379 STANAFORD RD |
| City | BECKLEY |
| State | WV |
| Zip Code | 25801-3141 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487651717 | Oluyemisi R. Sangodeyi | Surgery | 379 Stanaford Rd, Beckley, WV 25801-3141 | 2005-07-01 |
| 1073071627 | Donna Miller | Social Worker | 379 Stanaford Rd, Beckley, WV 25801-3141 | 2019-03-03 |
| 1770052268 | Miles Flint Puckett | Specialist/Technologist, Other | 379 Stanaford Rd, Beckley, WV 25801-3141 | 2018-11-14 |
| 1194200147 | Stephanie Diane Lilly | Nurse Practitioner | 379 Stanaford Rd, Beckley, WV 25801-3141 | 2018-09-26 |
| 1104368505 | Med Surg Group, Inc. | Clinic/Center | 379 Stanaford Rd, Beckley, WV 25801-3141 | 2016-11-16 |
| 1164822987 | Kelly Lynne Matherly | Nurse Practitioner | 379 Stanaford Rd, Beckley, WV 25801-3141 | 2014-08-28 |
| 1003127432 | Ahmad Eter | Internal Medicine | 379 Stanaford Rd, Beckley, WV 25801-3141 | 2010-06-30 |
| 1326069170 | Med-surg Group Incorporated | Family Medicine | 379 Stanaford Rd, Beckley, WV 25801-3141 | 2006-07-21 |
| 1821029190 | Judith K. Mckinney | Nurse Practitioner | 379 Stanaford Rd, Beckley, WV 25801-3141 | 2006-07-05 |
| 1427086727 | Barry Alan Levin | Orthopaedic Surgery | 379 Stanaford Rd, Beckley, WV 25801-3141 | 2006-06-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144835190 | Misty Dawn Chambers | Psychologist | 154 Lagoon Way, Beckley, USA 25801 | 2020-09-15 |
| 1912511437 | Katherine Lynne Mcghee | Technician | 120 Schlager Dr., Beckley, WV 25801 | 2020-09-02 |
| 1255942421 | Tyesha Burger | Technician | 442 Industrial Dr, Beckley, WV 25801 | 2020-08-12 |
| 1053920553 | Angela Sanches | Case Manager/Care Coordinator | 134 Gooseberry Ln, Beckley, WV 25801 | 2020-07-30 |
| 1871119933 | Tiffani Michelle Dale | Counselor | 111 Coral Court, Apt 5, Beckley, WV 25801 | 2020-06-24 |
| 1679046049 | Liberty Dental Centers | Dentist | 102 Galleria Plaza, Beckley, WV 25801 | 2019-01-08 |
| 1952884942 | Susan Rae Rash | Nurse Practitioner | 250 Stanaford Rd Ste 203, Beckley, WV 25801 | 2018-09-14 |
| 1689169039 | Megan Rae Walker | Dentist | 3153 Robert C. Byrd Drive, Beckley, WV 25801 | 2018-06-28 |
| 1104318625 | Mountain State Vascular, Inc. | Surgery | 121 George Street, Beckley, WV 25801 | 2018-05-31 |
| 1356841100 | Harper Road Treatment Center LLC | Family Medicine | 1802 Harper Rd Ste 202, Beckley, WV 25801 | 2018-02-19 |
| Find all providers in zip 25801 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538572474 | Eulanda Saunders | Specialist | 3049 Robert C. Byrd Dr., Ste 340, Beckley, WV 25801 | 2014-06-09 |
| 1801137104 | Charles F Bou-abboud Md Pllc | Specialist | 58 Brookshire Ln, Beckley, WV 25801-6765 | 2013-03-12 |
| 1841522620 | Responsible Pain & Aesthetic Management | Specialist | 310 George St., Beckley, WV 25801 | 2010-02-04 |
| 1275687402 | Adnan N. Silk | Specialist | 1902 Harper Rd Ste A, Beckley, WV 25801-2642 | 2007-01-23 |
| 1285785451 | Dee-dee Daniel | Specialist | 2233 S Kanawha St, Beckley, WV 25801-6719 | 2007-01-15 |
| 1902966799 | Lisa R Roles | Specialist | 3875 Robert C Byrd Dr, Beckley, WV 25801 | 2006-12-11 |
| 1720167687 | Ali Ahmad Suleiman | Specialist | 242 George St, Beckley, WV 25801-2641 | 2006-11-03 |
| 1861575839 | P.c. Corro M.d., Inc | Specialist | 251 Stanaford Rd, Beckley, WV 25801-3139 | 2006-10-23 |
| 1003911074 | Ahmad Ayman Khiami | Specialist | 110 Professional Park, Beckley, WV 25801-3623 | 2006-09-14 |
| 1063454767 | Emmit Rusell Worley Jr. | Specialist | 116 Crown St, Beckley, WV 25801-9328 | 2006-06-10 |
| Find all providers in BECKLEY | ||||
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| 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.