Provider Demographics
NPI:1235446485
Name:PRINCETON COMMUNITY HOSPITAL ASSN., INC
Entity Type:Organization
Organization Name:PRINCETON COMMUNITY HOSPITAL ASSN., INC
Other - Org Name:BLUEFIELD INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-487-7505
Mailing Address - Street 1:PO BOX 1369
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-1369
Mailing Address - Country:US
Mailing Address - Phone:304-487-7451
Mailing Address - Fax:
Practice Address - Street 1:2111 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-2002
Practice Address - Country:US
Practice Address - Phone:276-322-4661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
49-8914OtherCMS CERTIFICATION NUMBER