Provider Demographics
NPI:1992926737
Name:WHEELING SURGICAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:WHEELING SURGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-233-2455
Mailing Address - Street 1:P O BOX 6922
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-233-2455
Mailing Address - Fax:304-233-6073
Practice Address - Street 1:2115 CHAPLINE ST
Practice Address - Street 2:SUITE 308
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-233-2455
Practice Address - Fax:304-233-6073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2351860Medicaid
WV4000535000Medicaid
OH9327103Medicare ID - Type Unspecified
WV9327101Medicare ID - Type Unspecified
WV9327104Medicare ID - Type Unspecified
OH2351860Medicaid