Provider Demographics
NPI:1346266848
Name:BLUESTONE HEALTH ASSOCIATION, INC.
Entity Type:Organization
Organization Name:BLUESTONE HEALTH ASSOCIATION, INC.
Other - Org Name:BLUESTONE HEALTH CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:HUTCHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-431-5499
Mailing Address - Street 1:3997 BECKLEY RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-7660
Mailing Address - Country:US
Mailing Address - Phone:304-431-5499
Mailing Address - Fax:304-431-3400
Practice Address - Street 1:3997 BECKLEY RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-7660
Practice Address - Country:US
Practice Address - Phone:304-431-5499
Practice Address - Fax:304-431-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVCD7656OtherRR MC
WV001706661OtherBCBS
WV0035334000Medicaid
WV001776052OtherBCBS
WV0022360001Medicaid
WV0035334000Medicaid