National Provider Identifier Database

MOUNTAIN STATE ORTHOPEDICS SPORTS MEDICINE
Neuromusculoskeletal Medicine, Sports Medicine

A Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine physician trained to be responsible for the continuous care in the field of sports medicine encompasses increased knowledge and understanding of osteopathic principles and practice and heightened technical skills of osteopathic manipulative medicine and integrates each of these into the management of the individual engaged in physical exercise (sports) whether as an individual or in team participation.


Contact Information

MOUNTAIN STATE ORTHOPEDICS & SPORTS MEDICINE
400 FAIRVIEW HEIGHTS RD
STE. 301
SUMMERSVILLE, WV26651-9308
Phone: 304-880-7988
Fax: 304-880-7987
Website:
Specialty Taxonomy Code
* Neuromusculoskeletal Medicine, Sports Medicine 204C00000X

* Indicates primary specialty

NPI Profile & details for MOUNTAIN STATE ORTHOPEDICS & SPORTS MEDICINE

NPI Number 1285821561
Legal business name
LBN
MOUNTAIN STATE ORTHOPEDICS & SPORTS MEDICINE
Authorized official WILLIAM CARSON - (PRESIDENT)
Entity Organization
Organization subpart No
Enumeration date 10/01/2007
Last updated 12/29/2008 - About 17 years ago
Sole proprietor1 Not specified
Identifiers
  • WV License #: WV18114
  • WV Medicaid: 0098219000
  • WV Other: 9286011 MEDICARE PROVIDER NUMBER
  • WV Other: 200025785 RAILROAD MEDICARE

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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