Provider Demographics
NPI:1487675336
Name:BLUEFIELD MENTAL HEALTH CENTER, PC
Entity Type:Organization
Organization Name:BLUEFIELD MENTAL HEALTH CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:PARVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:304-952-8637
Mailing Address - Street 1:5823 WINNBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-7894
Mailing Address - Country:US
Mailing Address - Phone:304-952-8637
Mailing Address - Fax:866-239-0601
Practice Address - Street 1:315 COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2421
Practice Address - Country:US
Practice Address - Phone:304-952-8637
Practice Address - Fax:866-239-0601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA418182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0201433000Medicaid
242366000OtherMAGELLAN
VA454028OtherANTHEM
036490OtherVALUE OPTIONS
379529OtherMAMSI
103632OtherFEDERAL BLACK LUNG
142001400OtherUS DEPARTMENT OF LABOR
WV000507728OtherBCBS WV DR.RIAZ
WV001708620OtherBCBS WV GROUP
WV0116701000Medicaid
VA7116934Medicaid
WV9320291Medicare ID - Type UnspecifiedGROUP NUMBER
WV0473295Medicare ID - Type UnspecifiedDOCTOR MEDICARE NUMBER
WV0116701000Medicaid
242366000OtherMAGELLAN
142001400OtherUS DEPARTMENT OF LABOR
C34984Medicare UPIN