Icp West Virginia LLC

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

ICP WEST VIRGINIA LLC

Practice address

500 Cherry St
Bluefield, WV 24701-3306

Phone

(304) 327-1100

NPI assigned

Nov 13, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Matthew Jackson

Title

Authorized Official

Phone

(813) 746-3993

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1542067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542067200000",
    "number": "1134698798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 671281",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752671281",
            "telephone_number": "813-746-3993",
            "fax_number": "904-265-8181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 CHERRY ST",
            "city": "BLUEFIELD",
            "state": "WV",
            "postal_code": "247013306",
            "telephone_number": "304-327-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICP WEST VIRGINIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-13",
        "last_updated": "2018-11-13",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "813-746-3993"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Javan Huckleberry
• Makayla Hudgins
• Emilee Huffman, APRN, FNP-BC
• Alexandria Hurt
• Brittany Hyatt
• Integrated WV LLC
• Internal Medicine of Bluefield, PLLC
• Mary Isabelle
• Island Medical Bluefield LLC
• Island Medical Bluefield LLC

• Emergency Medicine Physician in Bluefield, WV
• Providers in Bluefield, WV by specialty
• Emergency Medicine Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.