Organization
JERRY N BLACK SURGICAL SUITE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NORMA L HAYMOND (ADMINISTRATOR)
(304) 472-2100
Entity
Organization
Contact information
Practice address
10 AMALIA DRIVE, BUCKHANNON, WV 26201
(304) 472-2100
(304) 472-2118
Mailing address
10 AMALIA DRIVE, BUCKHANNON, WV 26201
(304) 472-2100
(304) 472-2118
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0096696001
—
WV
01
—
1445304
UMWA
—
Enumeration date
09/28/2006
Last updated
08/22/2020
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