MEDBROOK MEDICAL ASSOCIATES INC (NPI# 1013960632) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013960632 |
| Entity Type | Organization |
| Organization Name | MEDBROOK MEDICAL ASSOCIATES INC |
| Practice Address |
1370 Johnson Avenue Bridgeport WV 26330-1382 |
| Mailing Address |
Po Box 719 Dellslow WV 26531-0719 |
| Practice Telephone | 3048427186 |
| Practice Fax Number | 3048429005 |
| Mailing Telephone | 3048427186 |
| Mailing Fax Number | 3048429005 |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2012-02-14 |
| Authorized Official Name | MR. TIM G BUGIN (VP PAYOR CONTRACTING) |
| Authorized Official Telephone | 3042252500 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QU0200X |
Clinic/Center Specialization: Urgent Care |
Ambulatory Health Care Facilities | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WV | STATE LICENSE | 01265 | 01 |
| WV | MEDICAID LAB | 0010647002 | 01 |
| WV | CLIA | 51D0925226 | 01 |
| WV | 0010647000 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649292228 | Medbrook Medical Associates Inc | Pharmacy | 1370 Johnson Ave, Bridgeport, WV 26330-1492 | 2006-07-24 |
| Street Address |
1370 JOHNSON AVENUE |
| City | BRIDGEPORT |
| State | WV |
| Zip Code | 26330-1382 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225214240 | Natalie R King-selario | Family Medicine | 1370 Johnson Avenue, Bridgeport, WV 26330-1688 | 2008-01-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992303036 | Gage Mackenzie Chichester | Nurse Anesthetist, Certified Registered | 2673 Medical Park Drive, Bridgeport, WV 26330 | 2020-10-12 |
| 1851914105 | Melany Langhurst | Social Worker | 64 Professional Place, Suite 102, Bridgeport, WV 26330 | 2020-05-21 |
| 1245704980 | Adam Christopher Stonestreet | Social Worker | Community Care of Bridgeport, 65 Professional Place, Bridgeport, WV 26330 | 2019-01-16 |
| 1588146658 | Bridgeport Physical Therapy Services, Inc. | Occupational Therapist | 25 Sweetbrier Lane, Suite 105, Bridgeport, WV 26330 | 2018-09-05 |
| 1275040685 | White Oaks Assisted Living | Assisted Living Facility | 140 Professional Place White Oaks, Bridgeport, WV 26330 | 2018-01-08 |
| 1275049371 | Regional Eye Associates, Inc | Ophthalmology | 220 Southview Drive, Bridgeport, WV 26330 | 2017-12-27 |
| 1528586187 | Savanna Tamia Brown | Social Worker | 65 Professinal Place Suites 101,102103, Bridgeport, WV 26330 | 2017-09-05 |
| 1184079642 | Karla Kay Rinehart | Social Worker | 27 Trovato St., Suite 103, Bridgeport, WV 26330 | 2016-05-03 |
| 1396176756 | Willo Group LLC | Pharmacy | 460 E. Main Street, Bridgeport, WV 26330 | 2013-12-10 |
| 1891031878 | Sherri Michelle Dobson | Occupational Therapy Assistant | 1000 Maplewood Dr, Bridgeport, WV 26330 | 2012-12-20 |
| Find all providers in zip 26330 | ||||
| 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 |
|---|---|---|---|---|
| 1780158287 | Rejuvenation Medspa | Family Medicine | 1400 Johnson Ave Ste 4a, Bridgeport, WV 26330-1063 | 2019-01-17 |
| 1497244321 | Sanitas of Connecticut LLC | Family Medicine | 4551 Main St, Bridgeport, CT 06606-1818 | 2018-05-07 |
| 1023471299 | Qmg4, LLC | Family Medicine | 4200 Main Street, Bridgeport, CT 06606 | 2016-04-04 |
| 1013395755 | Clinisanitas, PC | Family Medicine | 4543 Main St, Bridgeport, CT 06606-1818 | 2015-05-14 |
| 1982941431 | Razia Sultana Hashmi | Family Medicine | 115 Highland Ave, Bridgeport, CT 06604-3549 | 2013-01-03 |
| 1508025594 | Awais Malik | Family Medicine | 754 Clinton Ave, Bridgeport, CT 06604-2301 | 2008-06-04 |
| 1508062423 | Bridgeport Family Practice Obgyn Clinic | Family Medicine | 615 Kendall Ave, Bridgeport, AL 35740 | 2007-06-26 |
| 1760505887 | Vinai Montricul | Family Medicine | 47910 Al Highway 277, Bridgeport, AL 35740-7206 | 2007-04-06 |
| 1942341060 | Zijad Sabovic | Family Medicine | 3000 Park Ave, Bridgeport, CT 06604-1105 | 2007-02-09 |
| 1538207295 | Bridgeport Family Health LLC | Family Medicine | 1381 Reservoir Avenue, Bridgeport, CT 06606-2502 | 2007-02-02 |
| Find all providers in BRIDGEPORT | ||||
| City | BRIDGEPORT |
| Zip Code | 26330 |
Please comment or provide details below to improve the information on MEDBROOK MEDICAL ASSOCIATES INC.
| 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.