Community Care of West Virginia, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

2287-7375 Issued in WV

Legal business name

COMMUNITY CARE OF WEST VIRGINIA, INC.

Doing business as

Nutter Fort Primary Wellness Center

Practice address

1302 Buckhannon Pike
Nutter Fort, WV 26301-4406

Phone

(304) 624-3275

Fax

(304) 624-3382

NPI assigned

Jun 26, 2013

Last updated

Jun 26, 2013By the provider in NPPES

Organization subpart

Yes

Parent organization

COMMUNITY CARE OF WEST VIRGINIA, INC.As reported in NPPES

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

Authorized official

Name

Dora L Potasnik

Title

Credentialing

Phone

(304) 587-2541

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Nutter Fort Primary Wellness Center Doing business as

Part of

Primary Care Systems Inc

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

{
    "created_epoch": "1372204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372204800000",
    "number": "1003256801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 217",
            "city": "ROCK CAVE",
            "state": "WV",
            "postal_code": "262340217",
            "telephone_number": "304-924-6262",
            "fax_number": "304-924-5460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1302 BUCKHANNON PIKE",
            "city": "NUTTER FORT",
            "state": "WV",
            "postal_code": "263014406",
            "telephone_number": "304-624-3275",
            "fax_number": "304-624-3382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CARE OF WEST VIRGINIA, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY CARE OF WEST VIRGINIA, INC.",
        "enumeration_date": "2013-06-26",
        "last_updated": "2013-06-26",
        "status": "A",
        "authorized_official_last_name": "POTASNIK",
        "authorized_official_first_name": "DORA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "304-587-2541"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WV",
            "license": "2287-7375",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUSINESS LICENSE",
            "identifier": "2287-7375",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nutter Fort Primary Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bridget Bunner
• Ashley Byrd
• Chiropractic Care Center PLLC
• Michelle Lynne Christmas, PTA
• Michelle Colev, M.D.
• Community Care of West Virginia, Inc. (Nutter Fort Intermediate Wellness Center)
• Travis Allen Cottrill, RN
• Holly Crayton
• John Byrnside Davis, DDS
• Benjamin Defazio

• Federally Qualified Health Center (FQHC) in Nutter Fort, WV
• Providers in Nutter Fort, WV by specialty
• Federally Qualified Health Center (FQHC) in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2013; 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.