MOUNTAIN STATE MEDICAL ASSOCIATES PLLC (NPI# 1447349238) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447349238 |
| Entity Type | Organization |
| Organization Name | MOUNTAIN STATE MEDICAL ASSOCIATES PLLC |
| Practice Address |
300 Kenton Dr Suite 100 Charleston WV 25311-1263 |
| Practice Telephone | 3043465533 |
| Practice Fax Number | 3043465611 |
| Mailing Telephone | 3043465533 |
| Mailing Fax Number | 3043465611 |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2015-11-05 |
| Authorized Official Name | JUSTIN DALE BAILEY (PRESIDENT) |
| Authorized Official Telephone | 3043465533 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 20410 | WV | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WV | BLUE CROSS NUMBER FOR THE GROUP | 001706175 | 01 |
| WV | 3810001081 | 05 | |
| WV | NPI NUMBER FOR THE GROUP | 1447349238 | 01 |
| WV | UMWA PIN NUMBER FOR THE GROUP | P00189318 | 01 |
| WV | UMWA NUMBER FOR THE GROUP | DC7713 | 01 |
| WV | RAILROAD NUMBER FOR THE GROUP | P00215125 | 01 |
| Street Address |
300 KENTON DR SUITE 100 |
| City | CHARLESTON |
| State | WV |
| Zip Code | 25311-1263 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760461164 | Kelli J Dumm | Internal Medicine | 300 Kenton Dr, Suite 100, Charleston, WV 25311-1263 | 2006-01-13 |
| 1215429378 | Jamie Carrier | Counselor | 300 Kenton Dr, Charleston, WV 25311-1266 | 2018-06-05 |
| 1427540673 | Jennifer Crum | Counselor | 300 Kenton Dr, Charleston, WV 25311-1266 | 2018-06-04 |
| 1194103069 | Coley Dunigan | Counselor | 300 Kenton Dr, Suite 200, Charleston, WV 25311-1266 | 2015-05-12 |
| 1619355567 | Krista Neophytou | Counselor | 300 Kenton Dr, Suite 200, Charleston, WV 25311-1266 | 2015-05-12 |
| 1689052532 | Dena Price | Counselor | 300 Kenton Dr, Suite 200, Charleston, WV 25311-1266 | 2015-05-12 |
| 1609270941 | Kvc | Community/Behavioral Health | 300 Kenton Dr, Suite 200, Charleston, WV 25311-1266 | 2014-10-15 |
| 1225385461 | Alicia Beth Harper | Nurse Practitioner | 300 Kenton Dr, Suite 100, Charleston, WV 25311-1266 | 2012-08-07 |
| 1285993519 | Alexander Ryan Epperly | Physician Assistant | 300 Kenton Dr, Suite 2, Charleston, WV 25311-1266 | 2012-05-07 |
| 1699071993 | Jessica Beth Salansky Md Pllc | Pediatrics | 300 Kenton Dr, Suite 100, Charleston, WV 25311-1263 | 2011-02-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184225476 | Darlene Lacy-carter | Technician | 1406 Milton Street, Charleston, WV 25311 | 2020-11-04 |
| 1942810452 | Joshua Reese | Technician | 1248 Valley Grove Rd, Charleston, WV 25311 | 2020-08-10 |
| 1538710785 | Pamela White | Technician | 542 Harmony Hollow Road, Charleston, WV 25311 | 2019-09-27 |
| 1780104083 | The Stairlift People, Inc | Public Health or Welfare | 2510 Kanawha Blvd East, Charleston, WV 25311 | 2017-06-27 |
| 1902271505 | Mary Workman | Registered Nurse | 1520 Wahington Street East, Charleston, WV 25311 | 2015-12-08 |
| 1871966564 | Ashley Nicole Lester | Occupational Therapy Assistant | 1000 Association Dr., Charleston, WV 25311 | 2015-11-04 |
| 1548671530 | Holly Markins | Social Worker | 300 Tracy Way, Charleston, WV 25311 | 2014-05-13 |
| 1124453964 | West Virginia Health Right, Inc. | Clinic/Center | 1520 Washington St. E., Charleston, WV 25311 | 2013-09-12 |
| 1457678005 | Sarah Lyn Tussey | Occupational Therapy Assistant | 1 Supthin Dr, Charleston, WV 25311 | 2010-04-22 |
| 1639344708 | Daymark Inc | Residential Treatment Facility, Emotionally Disturbed Children | 1592 Washington Street East, Suite 2, Charleston, WV 25311 | 2008-04-29 |
| Find all providers in zip 25311 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972128221 | John Fincher Gist Bobo | Internal Medicine | 169 Ashley Ave Rm 202muh, Charleston, SC 29425-8905 | 2020-06-12 |
| 1831746874 | Roper Saint Francis Physicians Network | Internal Medicine | 615 Wesley Dr Ste 120, Charleston, SC 29407-7206 | 2019-08-23 |
| 1104486463 | Matthew Bruner | Internal Medicine | 162 Ashley Ave Rm 202, Charleston, SC 29425-8907 | 2019-06-19 |
| 1366001760 | Rayphael Sebastian Hardy | Internal Medicine | 169 Ashley Avenue Room 202 Main Hospital Msc333, Charleston, SC 29425 | 2019-06-10 |
| 1427617950 | Emily Suzanne Nyers | Internal Medicine | 169 Ashley Ave., Room 202 Main Hospital, Msc 333, Charleston, SC 29425 | 2019-06-09 |
| 1225697931 | Shenia Lorraine Singleton | Internal Medicine | 706 Tahoe St, Charleston, SC 29407-6629 | 2019-06-07 |
| 1871152520 | Elena Vlachos | Internal Medicine | 169 Ashley Aveneue Room 202 Main Hospital, Charleston, SC 29425-0001 | 2019-06-06 |
| 1750877890 | Mona Ali Haj | Internal Medicine | 96 Jonathan Lucas St Rm 202, Charleston, SC 29425-8900 | 2018-07-02 |
| 1538654025 | Megan Kathleen Veglia | Internal Medicine | 135 Rutledge Ave Fl 8, Charleston, SC 29425-8905 | 2018-06-27 |
| 1457881559 | Milad Cesar El Hajj | Internal Medicine | 96 Jonathan Lucas St Ste 807, Charleston, SC 29425-8900 | 2017-06-13 |
| Find all providers in CHARLESTON | ||||
| City | CHARLESTON |
| Zip Code | 25311 |
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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.