| Organization Name: | MT. STATE ENT & FACIAL PLASTIC SURGERY, INC. |
| NPI Number: | 1033579636 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DOROTHY FARLEY (PRACTICE MANAGER) |
| Mailing Address: | 2 Westwood Professional Park Bluefield |
| State: | VA US |
| Postal Code: | 24605 |
| Phone Number: | 3042552341 |
| Fax Number: | 3042552343 |
| NPI Enumeration Date: | 02/25/2016 |
| NPI Last Update Date: | 02/25/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM2500X |
| License Number: | 006769 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Medical Specialty |
| Taxonomy Definition: | An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |