MOUNTAIN STATE VASCULAR, INC. – NPI #1104318625
Surgery

A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.

MOUNTAIN STATE VASCULAR, INC. is a surgeon located in BECKLEY, WV. NPPES has assigned the NPI number 1104318625 to MOUNTAIN STATE VASCULAR, INC. on May 31, 2018. It is a Type-2 NPI, indicating this NPI number is associated with an organization. According to the NPI data, there are 2 additional location(s) assigned to this provider which are listed below. The primary taxonomy selected by this provider is 2086S0129X from the Health Care Provider Taxonomy code set, which is classified as Surgery, specializing in Vascular Surgery

The NPI profile was previously updated about 2 years ago on May 22, 2024. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for MOUNTAIN STATE VASCULAR, INC. below.

NPI Profile for
MOUNTAIN STATE VASCULAR, INC.

NPI Number
1104318625
Enumeration Date

(more than 8 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
MOUNTAIN STATE VASCULAR, INC.
Primary location
121 GEORGE STREET
BECKLEY, WV 25801
Phone: (304) 250-0382 Fax:
2 Other location(s):
122 George St
Beckley, WV 25801-2608
Phone: (304) 250-0382
8849 Seneca Trl S
Ronceverte, WV 24970-8366
Phone: (304) 520-4966
Mailing address
PO BOX 1267
LEWISBURG, WV 24901-4267
Phone: (304) 890-9910 Fax:
Organization Subpart
No
Authorized Official
BRIAN WHYTE
OWNER
Phone: (304) 250-0382
Updated
Certification Date
May 22, 2024

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for MOUNTAIN STATE VASCULAR, INC.

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
otherSTATE OF WV CERTIFICATEWV9ALVR
otherWV BOARD OF MEDICINE REGISTRATIONWV1795
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
2086S0129X
- Surgery / Vascular Surgery (Primary)
WV 22852

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.