Provider Demographics
NPI:1063943678
Name:MED SURG PHYSICIAN GROUP, INC.
Entity type:Organization
Organization Name:MED SURG PHYSICIAN GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OLU
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANGODEYI
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:304-673-4294
Mailing Address - Street 1:104 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2408
Mailing Address - Country:US
Mailing Address - Phone:304-673-4294
Mailing Address - Fax:304-255-7884
Practice Address - Street 1:1902 HARPER RD STE ABC
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2642
Practice Address - Country:US
Practice Address - Phone:304-253-3000
Practice Address - Fax:304-929-2038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-24
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21042174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty