Organization
PARKERSBURG SURGICAL ASSOCIATES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN KEVIN KOCH M.D. (PARTNER)
(304) 865-4345
Entity
Organization
Contact information
Practice address
800 GRAND CENTRAL MALL, SUITE 2, VIENNA, WV 26105-4131
(304) 865-4345
(304) 420-5995
Mailing address
800 GRAND CENTRAL MALL, SUITE 2, VIENNA, WV 26105-4131
(304) 865-4345
(304) 420-5995
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005186653
AETNA
WV
05
—
0011154000
—
WV
01
—
001707362
MOUNTAIN STATE BCBS
WV
01
—
1043080
WV COMP
WV
05
—
2197448
—
OH
01
—
9298571
MEDICARE PTAN
WV
Enumeration date
07/13/2006
Last updated
08/11/2011
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