Provider Demographics
NPI:1982274965
Name:MED SURG PHYSICIAN GROUP, INC.
Entity type:Organization
Organization Name:MED SURG PHYSICIAN GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:OLU
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANGODEYI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, CEO
Authorized Official - Phone:304-253-3000
Mailing Address - Street 1:379 STANAFORD RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3141
Mailing Address - Country:US
Mailing Address - Phone:304-253-3000
Mailing Address - Fax:304-929-2038
Practice Address - Street 1:101 MARTIN DR
Practice Address - Street 2:
Practice Address - City:MOUNT HOPE
Practice Address - State:WV
Practice Address - Zip Code:25880-1509
Practice Address - Country:US
Practice Address - Phone:304-253-3000
Practice Address - Fax:304-929-2038
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MED SURG PHYSICIAN GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-30
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty