Organization
APPALACHIAN HIGHWAY MEDICAL & SURGICAL CLINIC, PLLC
Active
Organization
APPALACHIAN HIGHWAY MEDICAL & SURGICAL CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOMINADOR YTI LAO M.D. (PHYSICIAN)
(304) 732-9045
Entity
Organization
Contact information
Practice address
APPALACHIAN HWY, RT. 10 EAST PINEVILLE, PINEVILLE, WV 24874-1274
(304) 732-9045
(304) 732-9055
Mailing address
APPALACHIAN HIGHWAY RT. 10 EAST PINEVILLE, PINEVILLE, WV 24874-1274
(304) 732-9045
(304) 732-9055
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
12700
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00182204
BLUE CROSS BLUE SHIELD
WV
05
—
0128304001
—
WV
01
—
1220372
CHA
WV
01
—
200001780
RAILROAD MEDICARE
WV
01
—
57799
UNICARE
WV
Enumeration date
11/15/2006
Last updated
01/07/2019
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