Organization
BLUESTONE HEALTH ASSOCIATION, INC.
Active
Other names
Prudich Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. REBECCA KISH (CREDENTIALING SPECIALIST)
(304) 431-5499
Entity
Organization
Contact information
Practice address
5451 SIMMONS RIVER ROAD, MONTCALM, WV 24737
(304) 589-3251
(304) 589-5363
Mailing address
5451 SIMMONS RIVER RD., MONTCALM, WV 24737
(304) 589-3251
(304) 589-5363
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001706661
BCBS
WV
05
—
0022360001
—
WV
05
—
0035334000
—
WV
01
—
CD7656
RR MC
WV
Enumeration date
11/29/2006
Last updated
05/12/2022
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