Korey Blake Mitchell, MD
Individual provider Active NPI Family Medicine Physician · Fort Gay, WV
NPI 1295028546 · NPPES record last updated Nov 13, 2020
Key facts
- NPI
- 1295028546
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 25693 (WV)
- Practice address
- 71 Wayne St
Fort Gay, WV 25514-8518 - Phone
- (304) 648-5544
- Fax
- (304) 648-5989
- NPI assigned
- May 19, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 9
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Valley Health Systems, Inc
Practice addresses (Care Compare)
6350 US Route 60 E
Barboursville, WV 25504-1232
Phone (304) 399-3350
Hospital & facility affiliations
- Dignity Home Health
- Logan Regional Medical Center
- Three Rivers Medical Center
- Tug Valley Arh Regional Medical Center
- Cabell Huntington Hospital, Inc
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140827002994 | WV | Practitioner - Family Practice | 4981843356 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25693 | WV | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Valley Health Systems Inc | Family Medicine | Current | Accepting new patients |
| Valley Health Systems Inc | Family Medicine | Current | Accepting new patients |
| Valley Health Systems, Inc. | Current |
Accepting new patients | |
| Valley Health Systems Inc | Family Medicine | Current | Accepting new patients |
| Valley Health Systems Inc | Family Medicine | Current |
Accepting new patients |
| Valley Health Systems Inc | Current | Accepting new patients | |
| Valley Health Systems Inc | Family Medicine | Current | Accepting new patients |
| Valley Health Systems, Inc. | Family Medicine | Current |
Accepting new patients |
| Valley Health Systems Inc | Family Medicine | Past | Accepting new patients |
Locations
6350 US Route 60 E
Barboursville, WV 25504
Phone (304) 399-3350
71 Wayne St
Fort Gay, WV 25514
Phone (304) 648-5544
1301 Hal Greer Blvd
Huntington, WV 25701
Phone (304) 525-0572
2585 3rd Ave
Huntington, WV 25703
Phone (304) 697-1396
Interoperability endpoints
- kmitchell20217@valleyhealthsystems.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Family Medicine Physician | 207Q00000X | 25693 | WV | Yes |
Addresses
Primary practice location
71 Wayne St
Fort Gay, WV 25514-8518
Mailing address
PO Box 1680
Huntington, WV 25717-1680
Phone (304) 697-1396
Other practice location 1
3 Adena Dr
Kermit, WV 25674-8063
Phone (304) 393-4090
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100303880 | Medicaid | KY | |
| 0104755 | Medicaid | OH | |
| 3810027586 | Medicaid | WV |
Other providers in Fort Gay, WV
- Sherry Lynn Marcum
- Thomas Sebastian Marcum
- Ella Victoria Maynard
- Baileigh Nycole McKenzie
- Karen Jean Minney
- Edward Moran Jr.
- Chasity Mullens
- Syndey Paige Mullins
- Jada Leetta Muncy
- Jenna Leann Murray
All providers in Fort Gay, WV · Family Medicine Physician in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 13, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.