Mountain State Medical Specialties,Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

MOUNTAIN STATE MEDICAL SPECIALTIES,INC.

Practice address

120 Medical Park Dr Ste 101
Bridgeport, WV 26330-9013

Phone

(304) 624-7200

Fax

(304) 624-0026

NPI assigned

Mar 11, 2014

Organization subpart

No

Name

Evelyn McGee

Title

VP

Phone

(304) 624-7200

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 11, 2014.

{
    "created_epoch": "1394496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394496000000",
    "number": "1154747442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 N 6TH ST",
            "city": "CLARKSBURG",
            "state": "WV",
            "postal_code": "263012665",
            "telephone_number": "304-624-7200",
            "fax_number": "304-624-0026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 MEDICAL PARK DR STE 101",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263309013",
            "telephone_number": "304-624-7200",
            "fax_number": "304-624-0026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATE MEDICAL SPECIALTIES,INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-11",
        "last_updated": "2014-03-11",
        "status": "A",
        "authorized_official_last_name": "MCGEE",
        "authorized_official_first_name": "EVELYN",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "304-624-7200"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "MO 9307351",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Saad Mossallati, M.D.
• Mountain Laurel Psychiatry LLC
• Mountain Momma & Family Services, LLC
• Mountain River Physical Therapy, LLC
• Mountain State Medical Specialties, PLLC
• Mountainear Audiology & Hearing Aid Center, LLC
• Mountaineer Family Practice PLLC
• Mountaineer Medical Office Building Pharmacy
• Mountaineer Medical Pharmacy LLC
• Mountaineer Orthodontics, PLLC

• All providers in Bridgeport, WV
• Clinical Medical Laboratory in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.