NPIMap

Organization Active NPI

Kanawha Surgicenter

  • Specialist
  • Charleston, WV
National Provider Identifier
1619038676
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
10453 Issued in WV
Legal business name
KANAWHA SURGICENTER
Practice address
4803 Maccorkle Ave SE
Charleston, WV 25304-1948
Phone
(304) 925-6390
Fax
(304) 925-7931
NPI assigned
Dec 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Gorli Harish, MD
Title
MD
Phone
(304) 925-6390

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174400000X 10453 WV Primary

Addresses

Primary practice location

4803 Maccorkle Ave SE
Charleston, WV 25304-1948

Mailing address

4803 Maccorkle Ave SE
Charleston, WV 25304-1948
Phone (304) 925-6390

Other identifiers 1

IdentifierTypeStateIssuer
0009812000MedicaidWV

Other names 1

  • Kanawha Surgicenter Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Kanawha Surgicenter2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619038676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4803 MACCORKLE AVE SE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041948",
            "telephone_number": "304-925-6390",
            "fax_number": "304-925-7931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4803 MACCORKLE AVE SE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041948",
            "telephone_number": "304-925-6390",
            "fax_number": "304-925-7931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KANAWHA SURGICENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HARISH",
        "authorized_official_first_name": "GORLI",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "304-925-6390",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "WV",
            "license": "10453",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0009812000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kanawha Surgicenter",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.