Organization
MOUNTAIN STATE MEDICAL SPECIALTIES,INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVELYN MCGEE (VP)
(304) 624-7200
Entity
Organization
Contact information
Practice address
120 MEDICAL PARK DR STE 101, BRIDGEPORT, WV 26330-9013
(304) 624-7200
(304) 624-0026
Mailing address
125 N 6TH ST, CLARKSBURG, WV 26301-2665
(304) 624-7200
(304) 624-0026
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MO 9307351
PTAN
WV
Enumeration date
03/11/2014
Last updated
03/11/2014
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