Organization
PREMIER MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHRISTINE D STURTEVANT (CEO)
(304) 808-6081
Entity
Organization
Contact information
Practice address
710 GENESIS BLVD, BRIDGEPORT, WV 26330-9668
(304) 808-6081
(304) 423-5032
Mailing address
PO BOX 1610, CLARKSBURG, WV 26302-1610
(304) 808-6081
(304) 423-5032
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
291U00000X
Clinical Medical Laboratory
51D0898849
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010197000
—
WV
01
—
001710500
BLUE CROSS BLUE SHIELD
WV
01
—
1540199
UMWA MEDICARE
WV
01
—
CJ7607
RAILROAD MEDICARE
WV
Enumeration date
09/21/2006
Last updated
07/21/2014
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