BLUESTONE HEALTH ASSOCIATION, INC. (NPI# 1043387327) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043387327 |
| Entity Type | Organization |
| Organization Name | BLUESTONE HEALTH ASSOCIATION, INC. |
| Other Organization Name | PRUDICH MEDICAL CENTER |
| Practice Address |
10001 Simmons River Road Montcalm WV 24740 |
| Mailing Address |
10001 Simmons River Road Montcalm WV 24737 |
| Practice Telephone | 3045893251 |
| Practice Fax Number | 3045895363 |
| Mailing Telephone | 3045893251 |
| Mailing Fax Number | 3045895363 |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2010-10-20 |
| Authorized Official Name | MRS. SHERRY GAIL AGNEW (CREDENTIALING BILLING MANAGER) |
| Authorized Official Telephone | 3044315499 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LC1500X |
Nurse Practitioner Specialization: Community Health |
Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WV | RR MC | CD7656 | 01 |
| WV | BCBS | 001706661 | 01 |
| WV | 0022360001 | 05 | |
| WV | 0035334000 | 05 |
| Other Name | Type Code |
|---|---|
| Prudich Medical Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003453317 | Bluestone Health Association, Inc. | Clinic/Center | 106 Thorn St, Princeton, WV 24740-3560 | 2019-12-05 |
| 1437508314 | Bluestone Health Association, Inc. | Clinic/Center | 324 Oakvale Rd Ste 12, Princeton, WV 24740-3829 | 2016-06-10 |
| 1912377813 | Bluestone Health Association, Inc. | Clinic/Center | 200 12th Street Ext, Princeton, WV 24740-2329 | 2015-10-05 |
| 1770950396 | Bluestone Health Association, Inc. | Clinic/Center | 3016 E Cumberland Rd, Bluefield, WV 24701-4858 | 2015-08-31 |
| 1346266848 | Bluestone Health Association, Inc. | Family Medicine | 3997 Beckley Rd, Princeton, WV 24740-7660 | 2006-07-15 |
| Street Address |
10001 SIMMONS RIVER ROAD |
| City | MONTCALM |
| State | WV |
| Zip Code | 24740 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427658632 | New Beginnings Therapy Services, LLC | Community/Behavioral Health | 616 Harrison Street, Princeton, WV 24740 | 2020-10-27 |
| 1215536222 | Right At Home | Home Health | 313 Locus St, Princeton, WV 24740 | 2020-10-21 |
| 1881208098 | Robin Lane | Technician | 174 Tea Kettle Road, Princeton, WV 24740 | 2020-09-04 |
| 1134739824 | Nona Arthur | Technician | 708 Bluefiled Ave, Princeton, WV 24740 | 2020-08-06 |
| 1851909014 | Tina B Altizer | Speech-Language Pathologist | 120 12th Street, Princeton, WV 24740 | 2020-07-14 |
| 1245712504 | Tracy Jean Mitchell | Speech-Language Pathologist | 1200 Mercer St, Princeton, WV 24740 | 2018-09-04 |
| 1700305240 | Tina Six | Registered Nurse | 1403 Honaker Avenue, Princeton, WV 24740 | 2017-09-15 |
| 1013449172 | Karin Cappa | Pharmacist | 669 Cornfield Rd, Princeton, WV 24740 | 2017-03-29 |
| 1942661723 | Virginia Chryssikos | Social Worker | 3016 E Cumberland Road, Bluestone Family Practice, Bluefield, WV 24740 | 2016-03-08 |
| 1477939460 | Kathy Diane Wyrick | Counselor | 220 South Walker Street, Princeton, WV 24740 | 2015-08-03 |
| Find all providers in zip 24740 | ||||
| Taxonomy Code | 363LC1500X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Community Health |
| Definition to come... |
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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.