MOUNTAIN STATE VASCULAR, INC.


Address: 121 George Street, Beckley, WV 25801
Phone: 3042500382

MOUNTAIN STATE VASCULAR, INC. (NPI# 1104318625) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1104318625
Entity Type Organization
Organization Name MOUNTAIN STATE VASCULAR, INC.
Practice Address 121 George Street
Beckley
WV 25801
Mailing Address Po Box 1267
Lewisburg
WV 24901-4267
Practice Telephone 3042500382
Mailing Telephone 3048909910
Enumeration Date 2018-05-31
Last Update Date 2018-06-18
Authorized Official Name DR. BRIAN ROLAND WHYTE (OWNER)
Authorized Official Telephone 3042500382
Authorized Official Credential MD
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 2086S0129X Surgery
Specialization: Vascular Surgery
22852 WV Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
WV STATE OF WV CERTIFICATE 9ALVR 01
WV WV BOARD OF MEDICINE REGISTRATION 1795 01

Provider Secondary Practice Location

Address Telephone Number Fax Number
8849 Seneca Trl S, Ronceverte, WV 249708366 3045204966
122 George St, Beckley, WV 258012608 3042500382

Office Location

Street Address 121 GEORGE STREET
City BECKLEY
State WV
Zip Code 25801

Providers in the same location

NPI Name Taxonomy Address Enumeration
1114571668 Brittany Lynn Miller Nurse Practitioner 121 George Street, Beckley, WV 25801 2019-08-01

Providers in the same zip code

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
1356841100 Harper Road Treatment Center LLC Family Medicine 1802 Harper Rd Ste 202, Beckley, WV 25801 2018-02-19
1154830578 Angela Dawn Norman Counselor 101 S. Eisenhower Dr., Beckley, WV 25801 2017-09-28
Find all providers in zip 25801

Taxonomy Information

Taxonomy Code 2086S0129X
Grouping Allopathic & Osteopathic Physicians
Classification Surgery
Specialization Vascular Surgery

Taxonomy Definition

A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]
- Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1922230218 Beckley Vascular Associates & Vein Care Institute,pllc Surgery 120 George Street, Beckley, WV 25801-2608 2009-08-20
1134428980 Kumar Rai Surgery 250 Stanaford Rd, Suite 202, Beckley, WV 25801 2011-03-18
1013185172 Albert Francois Olivier Surgery 122 George St, Beckley, WV 25801-2608 2008-02-12
1285814640 Beckley Vascular Associates Pllc Surgery 122 George St, Beckley, WV 25801-2608 2007-11-13
1649261330 Herbert P Oye Surgery 250 Stanaford Rd, Ste 203, Beckley, WV 25801-3140 2005-11-02

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1154961852 Usa Vein Clinics of Morgantown Pllc Surgery 1010 Suncrest Towne Centre Drive, Morgantown, WV 26505-0000 2020-01-10
1740749928 Foot and Ankle Clinic of The Virginias Inc Surgery 4141 Teays Valley Rd, Hurricane, WV 25526-9772 2019-03-18
1538661848 East Mountain Health Physicians, Inc. Surgery 1000 Tavern Rd Ste 200, Martinsburg, WV 25401-2853 2018-03-02
1861992174 Usa Vein Clinics of West Virginia Pllc Surgery 1010 Suncrest Towne Centre, Morgantown, WV 26505 2018-02-14
1154581973 Maryland Surgical Care PC Surgery 710 Somerset Blvd Ste 103, Charles Town, WV 25414-4998 2008-06-16
1790731503 Wheeling Heart Institute Inc Surgery 1021 Mt Dechantal Road, Wheeling, WV 26003 2006-05-25
1568450245 Vardhan Reddy Surgery 651 Colliers Way Ste 408, Weirton, WV 26062-5055 2005-10-07
1679567325 Randall V Lester Surgery 510 Cherry St, Suite 206, Bldg A, Bluefield, WV 24701-3338 2005-09-08
1710504048 Foot and Ankle Clinic of The Virginias Inc Surgery 6007 Us Route 60 E Ste 228, Barboursville, WV 25504-1042 2020-07-02
1235754581 Usa Vascular Center of Morgantown Pllc Surgery 1010 Suncrest Towne Centre, Morgantown, WV 26505 2020-06-12
Find all providers with the same taxonomy

Competitor

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City BECKLEY
Zip Code 25801

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Dataset Information

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.

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