| Mountain State Medical Associates Pllc | |
|
300 Kenton Dr Suite 100 Charleston WV 25311-1263 | |
| (304) 346-5533 | |
| (304) 346-5611 |
| Full Name | Mountain State Medical Associates Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 300 Kenton Dr, Charleston, West Virginia |
| Authorized Official Name and Position | Justin Dale Bailey (PRESIDENT) |
| Authorized Official Contact | 3043465533 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain State Medical Associates Pllc 300 Kenton Dr Suite 100 Charleston WV 25311-1263 Ph: (304) 346-5533 | Mountain State Medical Associates Pllc 300 Kenton Dr Suite 100 Charleston WV 25311-1263 Ph: (304) 346-5533 |
| NPI Number | 1447349238 |
|---|---|
| Provider Enumeration Date | 10/12/2006 |
| Last Update Date | 11/05/2015 |
| Medicare PECOS PAC ID | 8921062183 |
|---|---|
| Medicare Enrollment ID | O20041117000293 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447349238 | NPI | - | NPPES |
| P00189318 | Other | WV | UMWA PIN NUMBER FOR THE GROUP |
| DC7713 | Other | WV | UMWA NUMBER FOR THE GROUP |
| P00215125 | Other | WV | RAILROAD NUMBER FOR THE GROUP |
| 001706175 | Other | WV | BLUE CROSS NUMBER FOR THE GROUP |
| 1447349238 | Other | WV | NPI NUMBER FOR THE GROUP |
| 3810001081 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 20410 (West Virginia) | Primary |
| Provider Name | Teresa M Sitler |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164485983 PECOS PAC ID: 6507751021 Enrollment ID: I20040216000323 |
| Provider Name | Justin D Bailey |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992784243 PECOS PAC ID: 8123082385 Enrollment ID: I20041208000056 |
| Provider Name | Kelli Jo Dumm |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760461164 PECOS PAC ID: 0749226629 Enrollment ID: I20050630000561 |
| Provider Name | Elizabeth Johnson Young |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316165103 PECOS PAC ID: 0547324493 Enrollment ID: I20090121000737 |
| Provider Name | Alicia B Harper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225385461 PECOS PAC ID: 1153571302 Enrollment ID: I20121024000084 |
| Provider Name | Rebekah W Hoh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174299879 PECOS PAC ID: 5799174710 Enrollment ID: I20211112002618 |
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