Organization
MOUNTAINEER SURGICAL ASSOCIATES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUKE WELDON MARTIN M.D. (MANAGING MEMBER)
(304) 205-7912
Entity
Organization
Contact information
Practice address
331 LAIDLEY ST, SUITE 201, CHARLESTON, WV 25301-1619
(304) 205-7912
(304) 205-4694
Mailing address
PO BOX 11210, CHARLESTON, WV 25339-1210
(304) 205-7912
(304) 205-4694
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
22900
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104023795
CARELINK
WV
01
—
1457662579
UMWA HEALTH AND RETIREMENT FUNDS
WV
01
—
1457662579
WELLS FARGO (PEIA)
—
01
—
233279270
MSBCBS
WV
01
—
233279270
OHIO BUREAU OF WORKERS' COMPENSATION
—
05
—
3810018433
—
WV
01
—
615411900
DEPARTMENT OF LABOR
—
01
—
6336732
CIGNA
WV
01
—
DQ8194
RAILROAD MEDICARE
WV
Enumeration date
06/23/2010
Last updated
06/20/2018
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