Mountain State ENT & Facial Plastic Surgery, Inc

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

006769 Issued in WV

Legal business name

MOUNTAIN STATE ENT & FACIAL PLASTIC SURGERY, INC

Practice address

78 Brookshire LN
Beckley, WV 25801-6765

Phone

(304) 255-2341

Fax

(304) 255-2343

NPI assigned

Aug 1, 2005

Organization subpart

No

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

Authorized official

Name

Albert James Paine Jr., MDNPI 1760443162

Title

Owner; President

Phone

(304) 255-2341

Specialties & licenses 1

Addresses

Other names 2

• Mountain State ENT Other name
• Mountain State ENT and Facial Plastic Surgery Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Mountain State ENT & Facial Plastic Surgery, Inc

  • Massage Therapist
  • Beckley, WV
  • NPI 1649639048
  NPPES parent name

Practitioners 4

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

• Albert James Paine Jr., MD

  • Facial Plastic Surgery Physician
  • Beckley, WV
  • NPI 1760443162
  Medicare reassignment Authorized official
• Deana Michelle McCarty, FNP-C

  • Nurse Practitioner
  • Bastian, VA
  • NPI 1821541889

  WV

  Medicare reassignment NPD
• Kristina M. Killen, CFNP

  • Nurse Practitioner
  • Beckley, WV
  • NPI 1194764415
  NPD (past)
• Christopher L White, DO

  • Otolaryngology Physician
  • Lewisburg, WV
  • NPI 1306817689
  NPD (past)

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

{
    "created_epoch": "1122854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711670400000",
    "number": "1982604997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "78 BROOKSHIRE LN",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "258016765",
            "telephone_number": "304-255-2341",
            "fax_number": "304-255-2343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78 BROOKSHIRE LN",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "258016765",
            "telephone_number": "304-255-2341",
            "fax_number": "304-255-2343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATE ENT & FACIAL PLASTIC SURGERY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-01",
        "last_updated": "2024-03-29",
        "certification_date": "2024-03-29",
        "status": "A",
        "authorized_official_last_name": "PAINE",
        "authorized_official_first_name": "ALBERT",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER; PRESIDENT",
        "authorized_official_telephone_number": "304-255-2341",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "WV",
            "license": "006769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mountainstateent@allmedsccd.com",
            "affiliation": "N",
            "address_1": "86 Brookshire Ln",
            "city": "Beckley",
            "state": "WV",
            "country_code": "US",
            "postal_code": "258016765",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Mountain State ENT",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Mountain State ENT and Facial Plastic Surgery",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Rose Morton
• Laura B Moten
• Tammy Maxine Moten
• Mountain State Counseling Services, LLC
• Mountain State ENT & Facial Plastic Surgery, Inc
• Mountain State Home Health Care Inc
• Mountain State Home Health Care, Inc.
• Mountain State Vascular, Inc.
• Mountaineer Cardiovascular Care Inc
• Mountaineer Family Medicine Inc

• Medical Specialty Clinic/Center in Beckley, WV
• Providers in Beckley, WV by specialty
• Medical Specialty Clinic/Center in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.