East River Psychiatry
Organization Active NPI Psychiatry Physician · Bluefield, VA
NPI 1689445884 · NPPES record last updated Feb 12, 2024
Key facts
- NPI
- 1689445884
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatry Physician 2084P0800X
- Legal business name
- EAST RIVER PSYCHIATRY
- Practice address
- 105 Westwood CMN
Bluefield, VA 24605-2031 - Phone
- (276) 235-6232
- Fax
- (276) 250-5117
- NPI assigned
- Jan 16, 2024
- Organization subpart
- No
Authorized official
- Name
- Holly Disibbio, NP
- Title
- Employee
- Phone
- (301) 904-3804
Practitioners 4
-
Holly Disibbio, PMHNP-BC
-
Jeffry Travis Gee, M.D.
-
Ira Ted Webb Jr., PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VA, WV
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240403001689 | VA | Part B Supplier - Clinic/Group Practice | 6800234311 |
Receives reassigned benefits from 4 practitioners Practice locations: Bluefield, VA |
| O20240426000932 | WV | Part B Supplier - Clinic/Group Practice | 6800234311 |
Receives reassigned benefits from 4 practitioners Practice locations: Bluefield, WV |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician |
2084P0800X | Yes | ||
| Community/Behavioral Health Agency | 251S00000X |
Addresses
Primary practice location
105 Westwood CMN
Bluefield, VA 24605-2031
Mailing address
105 Westwood CMN
Bluefield, VA 24605-2031
Phone (276) 235-6232
Other providers in Bluefield, VA
- Hilary Beth Deskins
- Holly Disibbio
- Bobby Quentin Dunford
- Donna Elaine Dunford
- Alfred James Dyer
- Constance L. Erickson
- Kimberly Erskin
- Emily Evans
- Ralph Evans
- Family Preservation Service Inc
All providers in Bluefield, VA · Psychiatry Physician in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 12, 2024. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.