Jerry N Black Surgical Suite

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

JERRY N BLACK SURGICAL SUITE

Practice address

10 Amalia Drive
Buckhannon, WV 26201

Phone

(304) 472-2100

Fax

(304) 472-2118

NPI assigned

Sep 28, 2006

Organization subpart

No

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

Authorized official

Name

Norma L Haymond

Title

Administrator

Phone

(304) 472-2100

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1992896310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 AMALIA DRIVE",
            "city": "BUCKHANNON",
            "state": "WV",
            "postal_code": "26201",
            "telephone_number": "304-472-2100",
            "fax_number": "304-472-2118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 AMALIA DRIVE",
            "city": "BUCKHANNON",
            "state": "WV",
            "postal_code": "26201",
            "telephone_number": "304-472-2100",
            "fax_number": "304-472-2118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY N BLACK SURGICAL SUITE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HAYMOND",
        "authorized_official_first_name": "NORMA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "304-472-2100"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMWA",
            "identifier": "1445304",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0096696001",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gabriella Jenab, PHARMD
• Janice Arlene Jenkins
• Spencer D Jenkins Jr., ATC
• Thomas Scott Jenks, CRNA
• Stephen H Jeran, D.D.S.
• Sheyenne Jett
• JK Marketing, LLC
• Johns, Conde & Malone, D.D.S., Inc.
• Stephen Smith Johns, DDS
• Lori Johnson

• Ophthalmology Physician in Buckhannon, WV
• Providers in Buckhannon, WV by specialty
• Ophthalmology Physician in West Virginia

• 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.