Organization
GREAT TEAYS MEDICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE D RAY (BILLING MANAGER)
(304) 760-9250
Entity
Organization
Contact information
Practice address
3703 TEAYS VALLEY RD, HURRICANE, WV 25526-9645
(304) 760-9250
(304) 760-9290
Mailing address
3703 TEAYS VALLEY RD, HURRICANE, WV 25526-9645
(304) 760-9250
(304) 760-9290
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
—
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007342019
AETNA/US HEALTHCARE
WV
05
—
3810001783
—
WV
01
—
5425070001
MEDICARE DMERC
WV
01
—
DB5783
RAILROAD MEDICARE
WV
Enumeration date
10/25/2006
Last updated
08/22/2020
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