Healthcare Provider Details

I. General information

NPI: 1124556352
Provider Name (Legal Business Name): BLUEFIELD COLLEGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2017
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 COLLEGE AVE
BLUEFIELD VA
24605-2050
US

IV. Provider business mailing address

3000 COLLEGE AVE
BLUEFIELD VA
24605-2050
US

V. Phone/Fax

Practice location:
  • Phone: 972-367-4845
  • Fax:
Mailing address:
  • Phone: 276-326-4281
  • Fax: 276-326-4481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIKA ELAINE BELL
Title or Position: DIRECTOR OF SPORTS MEDICINE
Credential:
Phone: 276-326-4281