Organization
MORGANTOWN SURGICAL ASSOCIATES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEROME GORDON JOHNSON M.D. (PRESIDENT)
(304) 599-1448
Entity
Organization
Contact information
Practice address
200 WEDGEWOOD DR, SUITE 202, MORGANTOWN, WV 26505-2442
(304) 599-1448
(304) 599-5335
Mailing address
200 WEDGEWOOD DR, SUITE 202, MORGANTOWN, WV 26505-2442
(304) 599-1448
(304) 599-5335
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
—
—
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011401000
—
WV
01
—
001709635
BLUE CROSS BLUE SHIELD
—
01
—
2630675
MEDICAID OF OHIO
—
01
—
610308000
OWPC
—
01
—
64239
UNISON
—
Enumeration date
10/23/2006
Last updated
06/22/2010
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