Organization
MOUNTAIN STATE MEDICAL ASSOCIATES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN DALE BAILEY MD (PRESIDENT)
(304) 346-5533
Entity
Organization
Contact information
Practice address
300 KENTON DR, SUITE 100, CHARLESTON, WV 25311-1263
(304) 346-5533
(304) 346-5611
Mailing address
300 KENTON DR, SUITE 100, CHARLESTON, WV 25311-1263
(304) 346-5533
(304) 346-5611
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
20410
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001706175
BLUE CROSS NUMBER FOR THE GROUP
WV
01
—
1447349238
NPI NUMBER FOR THE GROUP
WV
05
—
3810001081
—
WV
01
—
DC7713
UMWA NUMBER FOR THE GROUP
WV
01
—
P00189318
UMWA PIN NUMBER FOR THE GROUP
WV
01
—
P00215125
RAILROAD NUMBER FOR THE GROUP
WV
Enumeration date
10/12/2006
Last updated
11/05/2015
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