| Organization Name: | TYGART VALLEY MEDICAL SPECIALTIES, INC |
| NPI Number: | 1235596677 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STEPHEN CROSS (CEO) |
| Mailing Address: | 911 Gorman Ave Ste 201 Elkins |
| State: | WV US |
| Postal Code: | 262413154 |
| Phone Number: | 3046376302 |
| Fax Number: | 3046376307 |
| NPI Enumeration Date: | 01/15/2016 |
| NPI Last Update Date: | 03/16/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | 21597 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |