Basic Information
| Provider Information | |||||||||
| NPI: | 1033108733 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BIRD | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | CLAUDE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3997 BECKLEY RD | ||||||||
| Address2: | |||||||||
| City: | PRINCETON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 24740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044315499 | ||||||||
| FaxNumber: | 3044313400 | ||||||||
| Practice Location | |||||||||
| Address1: | 3997 BECKLEY RD | ||||||||
| Address2: | BLUESTONE HEALTH ASSOC | ||||||||
| City: | PRINCETON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 24740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044315499 | ||||||||
| FaxNumber: | 3044313400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2005 | ||||||||
| LastUpdateDate: | 06/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 13911 | WV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001706661 | 01 | WV | BCBS | OTHER | 0035334000 | 05 | WV | MEDICAID | 0051867000 | 05 | WV | MEDICAID | 001719931 | 01 | WV | BCBS | OTHER | CD7656 | 01 | WV | RR MC | OTHER |