MT. STATE ENT & FACIAL PLASTIC SURGERY, INC. (NPI# 1033579636) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033579636 |
| Entity Type | Organization |
| Organization Name | MT. STATE ENT & FACIAL PLASTIC SURGERY, INC. |
| Other Organization Name | MT. STATE ENT - BLUEFIELD |
| Practice Address |
2 Westwood Professional Park Bluefield VA 24605 |
| Mailing Address |
84 Brookshire Ln Beckley WV 25801-6765 |
| Practice Telephone | 3042552341 |
| Practice Fax Number | 3042552343 |
| Mailing Telephone | 3042552341 |
| Mailing Fax Number | 3042552343 |
| Enumeration Date | 2016-02-25 |
| Last Update Date | 2016-02-25 |
| Authorized Official Name | DOROTHY FARLEY (PRACTICE MANAGER) |
| Authorized Official Telephone | 3042552341 |
| Authorized Official Credential | MA, CPC, CMOM, C |
| Is Organization Subpart | Y |
| Parent Organization Name | MT. STATE ENT & FACIAL PLASTIC SURGERY, INC. |
| Parent Organization TIN |
|
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
006769 | WV | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PTAN | F093 | 01 |
| Other Name | Type Code |
|---|---|
| Mt. State ENT - Bluefield | Other Name - Individual/Organization |
| Street Address |
2 WESTWOOD PROFESSIONAL PARK |
| City | BLUEFIELD |
| State | VA |
| Zip Code | 24605 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619539954 | Meghan Lee Bohach | Specialist/Technologist | 3000 College Dr., Bluefield, VA 24605 | 2019-07-08 |
| 1053719229 | Erika Elaine Bell | Specialist/Technologist | 3000 College Ave, Bluefield, VA 24605 | 2014-12-19 |
| 1487948006 | Fermin Castro | Occupational Therapist | 20 Westwood Memorial Park, Bluefield, VA 24605 | 2011-05-31 |
| 1033422027 | Crewz LLC | Skilled Nursing Facility | Building 20, Westwood Medical Park, Bluefield, VA 24605 | 2010-07-19 |
| 1285966358 | Catherine Gillespie | Speech-Language Pathologist | 108 1/2 Spruce Street, Bluefield, VA 24605 | 2010-02-01 |
| 1790951432 | Derek S Buck | Physical Medicine & Rehabilitation | 111e Sanders Ln, Bluefield, VA 24605 | 2008-05-02 |
| 1275745994 | Christina Lynn Adkins | Occupational Therapist | Westwood Healthcare Center, Westwood Medical Park, Bluefield, VA 24605 | 2007-05-04 |
| 1215158100 | Beth Ann Reed | Physical Therapist | Westwood Center, Westwood Medical Park Rehab Department, Bluefield, VA 24605 | 2007-05-01 |
| 1164543559 | Constance L. Erickson | Speech-Language Pathologist | Westwood Office Park, Bluefield, VA 24605 | 2007-04-03 |
| 1649351164 | Mohammad Khalid Iqbal | Pediatrics | 2221 West Cumberland Rd, Bluefield, VA 24605 | 2006-10-18 |
| Find all providers in zip 24605 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770736431 | Allergy & Asthma Center of Bluefield, PC | Clinic/Center | 1240 Hockman Pike, Bluefield, VA 24605-9351 | 2008-10-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164056941 | Virginia Commonwealth University Health System Authority | Clinic/Center | 2495 Pocahontas Trl, Quinton, VA 23141-1637 | 2020-03-02 |
| 1306308382 | Jae Kim, Md Plc | Clinic/Center | 10721 Main St Ste 205, Fairfax, VA 22030-6902 | 2019-04-01 |
| 1861989105 | Lgn Weight Loss, LLC | Clinic/Center | 1114 E Main St Ste 6, Lebanon, VA 24266-5014 | 2018-04-20 |
| 1346746484 | Flex Massage Therapy, Inc | Clinic/Center | 700 Baker Rd Ste 115, Virginia Beach, VA 23462-1034 | 2018-04-05 |
| 1518471671 | Newtown Chiropractic Center Pllc | Clinic/Center | 5777 Princess Ann Road, Virginia Beach, VA 23462 | 2017-11-28 |
| 1346615390 | Caring Center Pllc | Clinic/Center | 19465 Deerfield Ave Ste 410, Leesburg, VA 20176-1708 | 2015-12-02 |
| 1093148314 | Ready Set Sleep Nurse LLC | Clinic/Center | 901 E Timber Branch Pkwy, Alexandria, VA 22302-3231 | 2013-08-11 |
| 1487944070 | Prince William Chiropractic Clinic | Clinic/Center | 2026 Opitz Blvd Ste B, Woodbridge, VA 22191-3332 | 2011-04-15 |
| 1356677306 | Hwang H. Junn Md Im/geri Plc | Clinic/Center | 4216 Evergreen Lane, Suite 111, Annandale, VA 22003-3253 | 2009-10-27 |
| 1891925509 | Dulles Internal Medicine, PC | Clinic/Center | 22636 Glenn Dr Ste 101, Sterling, VA 20164-4442 | 2009-07-16 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on MT. STATE ENT & FACIAL PLASTIC SURGERY, 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.