| Monogram Health Professional Services Of West Virginia Inc | |
|
1253 Canyon Rd Morgantown WV 26508-9273 | |
| (615) 673-4455 | |
| Not Available |
| Full Name | Monogram Health Professional Services Of West Virginia Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1253 Canyon Rd, Morgantown, West Virginia |
| Authorized Official Name and Position | Shawn Lynn Verner (SECRETARY AND GENERAL COUNSEL) |
| Authorized Official Contact | 6159941889 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Monogram Health Professional Services Of West Virginia Inc 5410 Maryland Way Ste 400 Brentwood TN 37027-8087 Ph: (615) 465-8684 | Monogram Health Professional Services Of West Virginia Inc 1253 Canyon Rd Morgantown WV 26508-9273 Ph: (615) 673-4455 |
| NPI Number | 1740999218 |
|---|---|
| Provider Enumeration Date | 11/23/2022 |
| Last Update Date | 01/29/2025 |
| Certification Date | 01/29/2025 |
| Medicare PECOS PAC ID | 8123498573 |
|---|---|
| Medicare Enrollment ID | O20221230000766 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740999218 | NPI | - | NPPES |
| Provider Name | Shaminder Gupta |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1730183401 PECOS PAC ID: 1658322300 Enrollment ID: I20230109000692 |
| Provider Name | Carrie R Hyde |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1114260726 PECOS PAC ID: 1658696307 Enrollment ID: I20231019002155 |
| Provider Name | Jaclyn Masulli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124565171 PECOS PAC ID: 5294149761 Enrollment ID: I20240417000715 |
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