| Michael M Boustany, MD | |
|
434 Division St, South Charleston, WV 25309 | |
| (304) 766-7140 | |
| (304) 766-7180 |
| Full Name | Michael M Boustany |
|---|---|
| Gender | Male |
| Speciality | General Surgery |
| Experience | 56 Years |
| Location | 434 Division St, South Charleston, West Virginia |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619973096 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2086S0129X | Surgery - Vascular Surgery | 10600 (West Virginia) | Secondary |
| 208600000X | Surgery | 10600 (West Virginia) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Thomas Memorial Hospital | South charleston, WV | Hospital |
| Charleston Area Medical Center | Charleston, WV | Hospital |
| Jackson General Hospital | Ripley, WV | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Ths Physician Partners Inc | 9537316393 | 236 |
| Entity Name | Ths Physician Partners Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1871866806 PECOS PAC ID: 9537316393 Enrollment ID: O20120829000738 |
| Mailing Address | Practice Location Address |
|---|---|
| Michael M Boustany, MD 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1311 Ph: (304) 414-4800 | Michael M Boustany, MD 434 Division St, South Charleston, WV 25309 Ph: (304) 766-7140 |
Seth Williams, MD Surgery Medicare: Medicare Enrolled Practice Location: 4607 Maccorkle Ave Sw Ste 400, South Charleston, WV 25309 Phone: 304-767-7900 | |
Johnna Michelle Jackson, D.O. Surgery Medicare: Accepting Medicare Assignments Practice Location: 500 Poplar St, Suite 304, South Charleston, WV 25309 Phone: 304-767-7770 Fax: 304-767-7779 | |
Kristen Price Eads, M.D. Surgery Medicare: Accepting Medicare Assignments Practice Location: 500 Poplar St, Suite 304, South Charleston, WV 25309 Phone: 304-767-7770 Fax: 304-767-7779 |