# UPSHUR MEDICAL MANAGEMENT SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** St. Joseph's Physician Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295756559
- **Authorized official:** TONY ATKINS (CEO)
- **Authorized official phone:** (304) 473-2118

## Contact information

- **Practice address:** 10 AMALIA DR, SUITE B-1, BUCKHANNON, WV 26201-2271
- **Practice address phone:** (304) 473-2200
- **Practice address fax:** (304) 473-2057
- **Mailing address:** 10 AMALIA DR, SUITE B-1, BUCKHANNON, WV 26201-2271
- **Mailing address phone:** (304) 473-2200
- **Mailing address fax:** (304) 473-2057

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/22/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0009185000 | — | WV |