Provider Demographics
NPI:1184890808
Name:BLUEFIELD REGIONAL MEDICAL CENTER INC
Entity type:Organization
Organization Name:BLUEFIELD REGIONAL MEDICAL CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WHITTEKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-327-1100
Mailing Address - Street 1:2111 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605-2002
Mailing Address - Country:US
Mailing Address - Phone:
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:276-322-4663
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUEFIELD REGIONAL MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-02
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001209004Medicaid
WV000706715OtherMT STATE BLUE CROSS BLUE SHIELD
VA460110OtherANTHEM (BCBS OF VIRGINIA)
WV5100711Medicare PIN
WV0001209004Medicaid
VA460110OtherANTHEM (BCBS OF VIRGINIA)