NPIMap

Organization Active NPI

Roanoke Chowan Community Health Center Inc

Doing business as Woodland Primary Care

  • Federally Qualified Health Center (FQHC)
  • Woodland, NC
National Provider Identifier
1023675113
Registry record updated Mar 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ROANOKE CHOWAN COMMUNITY HEALTH CENTER INC
Doing business as
Woodland Primary Care
Practice address
108 W Main St
Woodland, NC 27897
Phone
(252) 587-3141
Fax
(252) 587-3145
NPI assigned
May 23, 2019
Last updated
Mar 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2025

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

Authorized official

Name
Lashun Huntley
Title
Interim Ceo
Phone
(336) 829-3198

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

108 W Main St
Woodland, NC 27897

Mailing address

PO Box 669
Ahoskie, NC 27910-0669
Phone (252) 209-0237

Other identifiers 1

IdentifierTypeStateIssuer
1023675113MedicaidNC

Other names 1

  • Woodland Primary Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050428001071 NC Part B Supplier - Clinic/Group Practice 7214983386 Receives reassigned benefits from 44 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ahoskie, NC; Aulander, NC; Colerain, NC; Creswell, NC; Murfreesboro, NC; Woodland, NC
O20200602003143 NC Part A Provider - Federally Qualified Health Center (FQHC) 7214983386 Practice locations: Woodland, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023675113. Details of each certification follow.

Federally qualified health center certification: CCN 341146

Legal name
ROANOKE CHOWAN COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 2, 2020
Last certification
Jun 2, 2020
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jul 23, 2004 in NC
Enrollment address
108 W Main St
Woodland, NC 27897-9802

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2161141Woodland Primary Care108 West Main Street, Woodland, NC 27897Certificate of waiverSep 30, 2027

National Provider Directory

National Provider Directory

Locations

113 Hertford County High Rd
#B
Ahoskie, NC 27910
Phone (252) 209-3375

312 Academy St S
Ste D
Ahoskie, NC 27910
Phone (252) 332-3548

1850 NC Highway 11
Murfreesboro, NC 27855
Phone (252) 367-2543

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Paulique Horton Individual Corporate DirectorBoard Member Sep 1, 2017
Kim a Schwartz Individual Corporate OfficerCeo Jun 27, 2005
Eleanor Lane Individual Corporate DirectorBoard Member Apr 1, 2019
Lillie Owens White Individual Corporate DirectorBoard Member Jul 1, 2016
Sheila Porter Individual Corporate DirectorBoard Member Jan 1, 2014
Terry R Hall Individual Corporate DirectorBoard Member Apr 1, 2008
Ernest R Carter Individual Corporate DirectorBoard Member Jul 1, 2012
Deborah D Morrison Individual Corporate DirectorBoard Member Jul 1, 2012
Viola Vaughan-Holland Individual Corporate DirectorBoard Member Dec 1, 2010
Luther Culpepper Individual Corporate DirectorBoard Member Dec 1, 2012
Jennifer Cobb Individual W-2 Managing EmployeeRevenue Cycle Manager Feb 24, 2006
Bonnie C Revelle Individual Corporate DirectorBoard Member Jul 1, 2012
Guy J Simmons Individual Corporate DirectorBoard Member Dec 1, 2012

Practitioners & affiliated clinicians

Practitioners 50

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 50

NPI Registry JSON

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

{
    "created_epoch": "1558569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741651200000",
    "number": "1023675113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 669",
            "city": "AHOSKIE",
            "state": "NC",
            "postal_code": "279100669",
            "telephone_number": "252-209-0237",
            "fax_number": "252-209-0197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 W MAIN ST",
            "city": "WOODLAND",
            "state": "NC",
            "postal_code": "27897",
            "telephone_number": "252-587-3141",
            "fax_number": "252-587-3145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROANOKE CHOWAN COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-23",
        "last_updated": "2025-03-11",
        "certification_date": "2025-03-11",
        "status": "A",
        "authorized_official_last_name": "HUNTLEY",
        "authorized_official_first_name": "LASHUN",
        "authorized_official_title_or_position": "INTERIM CEO",
        "authorized_official_telephone_number": "336-829-3198"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023675113",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Woodland Primary Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Woodland Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodland, NC

Sources for this page

Verify at the official NPI Registry.