Dr. Bose S. Mikkilineni, M.D. Facs

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

WV12282 Issued in WV

Legal business name

DR. BOSE S. MIKKILINENI, M.D. FACS

Practice address

419 Carriage Dr
Beckley, WV 25801-2805

Phone

(304) 253-8416

Fax

(866) 461-4726

NPI assigned

Apr 6, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Bose S Mikkilineni, M.D. Facs, M.D.

Title

Sole Proprietor

Phone

(304) 253-8416

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/1184/brand/1/csg/1/fhir/r4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bose S. Mikkilineni, M.D. FACS

  • Surgery Physician
  • Beckley, WV
  • NPI 1407840549
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357084800000",
    "number": "1124141171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "419 CARRIAGE DR",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "258012805",
            "telephone_number": "304-253-8416",
            "fax_number": "866-461-4726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 CARRIAGE DR",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "258012805",
            "telephone_number": "304-253-8416",
            "fax_number": "866-461-4726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. BOSE S. MIKKILINENI, M.D. FACS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2013-01-02",
        "status": "A",
        "authorized_official_last_name": "MIKKILINENI, M.D. FACS",
        "authorized_official_first_name": "BOSE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "304-253-8416",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "WV",
            "license": "WV12282",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0128502000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph Douglas, DDS
• Justin Wayne Douglas, MD
• Sandra Douglas
• Amy W Dowdy, D.O.
• Dr L E Syner and Dr W M Wine Assoc in Oral & Maxillofacial Surg Inc,
• Dr. Joseph M. Duda
• Dr. Rhonda Guy & Associates
• Jennifer Lynn Drake, PA-C
• DRS Brock, Henderson, Di Prisco, Ravelo and Green Inc
• DRS Brock, Henderson, Di Prisco, Ravelo and Green Inc

• Surgery Physician in Beckley, WV
• Providers in Beckley, WV by specialty
• Surgery Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.