| Organization Name: | MOUNTAIN STATE ORTHOPEDICS & SPORTS MEDICINE |
| NPI Number: | 1285821561 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WILLIAM R. CARSON (PRESIDENT) |
| Mailing Address: | 400 Fairview Heights Rd Ste. 301 Summersville |
| State: | WV US |
| Postal Code: | 266519308 |
| Phone Number: | 3048807988 |
| Fax Number: | 3048807987 |
| NPI Enumeration Date: | 10/01/2007 |
| NPI Last Update Date: | 12/29/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204C00000X |
| License Number: | WV18114 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Neuromusculoskeletal Medicine, Sports Medicine |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |