Organization
BLUESTONE HEALTH ASSOCIATION, INC.
Active
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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