BLUE MOUNTAIN MEDICAL CLINIC, PLLC (NPI# 1023538758) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023538758 |
| Entity Type | Organization |
| Organization Name | BLUE MOUNTAIN MEDICAL CLINIC, PLLC |
| Practice Address |
1814 Cumberland Ave Middlesboro KY 40965 |
| Mailing Address |
1814 Cumberland Ave Middlesboro KY 40965-1229 |
| Practice Telephone | 6062422519 |
| Practice Fax Number | 6062422520 |
| Mailing Telephone | 6062422519 |
| Mailing Fax Number | 6062422520 |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2018-06-26 |
| Authorized Official Name | TINA POORE (OFFICE MANAGER) |
| Authorized Official Telephone | 6062422519 |
| Is Organization Subpart | Y |
| Parent Organization Name | LIFE & HEALTH SERVICES |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | KY | Allopathic & Osteopathic Physicians |
| Street Address |
1814 CUMBERLAND AVE |
| City | MIDDLESBORO |
| State | KY |
| Zip Code | 40965 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376558148 | Shahzad Shahmalak | Psychiatry & Neurology | 1814 Cumberland Ave, Middlesboro, KY 40965-1229 | 2006-07-30 |
| 1497238398 | Appalachian Licensed Psychiatric Services, Pllc | Psychiatry & Neurology | 1814 Cumberland Ave, Middlesboro, KY 40965-1229 | 2018-09-07 |
| 1477974558 | Larra Williams | Social Worker | 1814 Cumberland Ave, Middlesboro, KY 40965-1229 | 2013-12-17 |
| 1619265071 | Premiertox 2.0 Inc. | Clinical Medical Laboratory | 1814 Cumberland Ave, Middlesboro, KY 40965-1229 | 2011-07-19 |
| 1629101068 | Rehabilitation Drug Services Inc | Psychiatry & Neurology | 1814 Cumberland Ave, Middlesboro, KY 40965-1229 | 2007-03-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396387064 | Christopher Bruce Ellison | Social Worker | 809 19th Street, Middlesboro, KY 40965 | 2019-10-14 |
| 1982255030 | Johnny Wade Nantz II | Case Manager/Care Coordinator | 809 N 19th St, Middlesboro, KY 40965 | 2019-09-20 |
| 1558827774 | August Pediatrics, LLC | Pediatrics | 123 N 19th St Ste 302, Middlesboro, KY 40965 | 2019-02-12 |
| 1558843227 | Bethany Lauren Wade | Case Manager/Care Coordinator | 19th St, 809, Middlesboro, KY 40965 | 2018-08-30 |
| 1124521505 | Sonya Joyce Mcneil | Speech-Language Pathologist | Kidabilities Pediatric Therapy Center, 2801 Highway 25e, Suite 98, Middlesboro, KY 40965 | 2018-03-13 |
| 1518499862 | Vikki Lynn Johnson | Case Manager/Care Coordinator | 809 North 19th Street, Middlesboro, KY 40965 | 2017-03-28 |
| 1184164287 | Wilson Jeffrey | Occupational Therapist | Address: 235 New Wilson Lane, Middlesboro, KY 40965 | 2017-03-08 |
| 1447797444 | Lesha Loretta Williams | Physician Assistant | 2004 Cumberland Ave Ste 100, Middlesboro, KY 40965 | 2017-01-27 |
| 1619423910 | Audra Anissa Hall | Physical Therapist | 108 Turner Lane, Middlesboro, KY 40965 | 2016-08-28 |
| 1700332061 | Tammy Mclain | Counselor | Selfrefind 809 North 19th Street, Middlesboro, KY 40965 | 2016-08-28 |
| Find all providers in zip 40965 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619447018 | Tonya Michelle Turpin | Family Medicine | 2826 Cumberland Ave, Middlesboro, KY 40965-1540 | 2018-11-28 |
| 1992186027 | Mayada Elian | Family Medicine | 3504 Cumberland Ave, Middlesboro, KY 40965 | 2015-06-15 |
| 1962908277 | Arh Mary Breckinridge Health Services, Inc. | Family Medicine | 3504 Cumberland Ave, Middlesboro, KY 40965 | 2018-04-04 |
| 1861939498 | Bright Future Primary Care | Family Medicine | 3602 Cumberland Ave Ste B102, Middlesboro, KY 40965-2614 | 2017-01-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841890431 | Alishia Gayle Euler | Family Medicine | 730 Della Dr, Lexington, KY 40504-3610 | 2020-11-01 |
| 1306443908 | Complete Wellness Inc | Family Medicine | 25 Joshua Lane, Hawesville, KY 42348 | 2020-10-06 |
| 1811503410 | Angela Coffman | Family Medicine | 1000 Thompson Dr, Beaver Dam, KY 42320-9152 | 2020-09-18 |
| 1871107375 | West Towne Clinical Services Pllc | Family Medicine | 2755 W Park Dr Ste 1, Paducah, KY 42001-9058 | 2020-09-02 |
| 1528670981 | Visium Healthlink LLC | Family Medicine | 507 Avawam Dr, Richmond, KY 40475-9195 | 2020-08-18 |
| 1114535911 | Lea Anne Bunch | Family Medicine | 12080 S Dixie Hwy, Sonora, KY 42776-9739 | 2020-07-17 |
| 1952929689 | Yasir LLC | Family Medicine | 103 Financial Pl Ste 300, Elizabethtown, KY 42701-4470 | 2020-07-09 |
| 1578188637 | Megan Elizabeth Burke | Family Medicine | 641 Zag Rd, West Liberty, KY 41472-7625 | 2020-06-14 |
| 1679197529 | Kentucky Mountain Interventional and Infusion Therapies, LLC. | Family Medicine | 101 Hibbard St Ste 200, Pikeville, KY 41501-1788 | 2020-06-05 |
| 1548883960 | Proactive Md Ky Psc | Family Medicine | 4340 Crittenden Dr, Louisville, KY 40209-1600 | 2020-05-20 |
| Find all providers with the same taxonomy | ||||
| City | MIDDLESBORO |
| Zip Code | 40965 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.