Basic Information
| Provider Information | |||||||||
| NPI: | 1669708442 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | APOGEE MEDICAL GROUP, WEST VIRGINIA, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 708760 | ||||||||
| Address2: | |||||||||
| City: | SANDY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840708760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013529500 | ||||||||
| FaxNumber: | 8013527976 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | LOGAN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 256013452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048311643 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2009 | ||||||||
| LastUpdateDate: | 03/29/2022 | ||||||||
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| AuthorizedOfficialLastName: | GREGORY | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CIO | ||||||||
| AuthorizedOfficialTelephone: | 6027783600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.