NPIMap

Organization Active NPI

Mountaineer Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Paw Paw, WV
National Provider Identifier
1033299862
Registry record updated Aug 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MOUNTAINEER COMMUNITY HEALTH CENTER, INC.
Practice address
783 Winchester St
Paw Paw, WV 25434-0002
Phone
(304) 947-5500
Fax
(304) 947-5563
NPI assigned
Oct 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2026

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

Authorized official

Name
Ms. Rebecca Thomas
Title
Ceo
Phone
(304) 947-5500

Specialties & licenses 1

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

Addresses

Primary practice location

783 Winchester St
Paw Paw, WV 25434-0002

Mailing address

PO Box 2
783 Winchester St
Paw Paw, WV 25434-0002
Phone (304) 947-5500

Other identifiers 2

IdentifierTypeStateIssuer
CC5660OtherWVRRMC
0035343000MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080605000019 WV Part B Supplier - Public Health/Welfare Agency 2769552504 Receives reassigned benefits from 8 practitioners
Practice locations: Paw Paw, WV
O20101209000538 WV Part A Provider - Federally Qualified Health Center (FQHC) 2769552504 Practice locations: Paw Paw, WV

Federally qualified health center certification: CCN 511858

Legal name
MOUNTAINEER COMMUNITY HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 6, 1997
Last certification
Feb 6, 1997
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 20, 1996 in WV
Enrollment address
783 Winchester St
Paw Paw, WV 25434-3258

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
51D0914378Mountaineer Community Health Center783 Winchester Street, Paw Paw, WV 25434Certificate of waiverJun 29, 2028

National Provider Directory

National Provider Directory

Locations

783 Winchester St
Paw Paw, WV 25434
Phone (304) 947-5500

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/11497/brand/1/csg/1/fhir/r4

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Cynthia Lease Individual Corporate OfficerSecretary Sep 1, 2018
Corporate Director Jan 1, 2018
Angela Newlon Individual Corporate Director Nov 11, 2021
Edward Ridgeway Individual Corporate OfficerPresident Sep 8, 2022
Corporate Director Sep 1, 2011
Jill Crist Individual Corporate Director Jan 13, 2022
Barbara Norton Individual Corporate Director Nov 30, 2010
Doreen P Burch Individual Corporate OfficerTreasurer Sep 19, 2019
Corporate Director Sep 19, 2019
Darlene Abe Individual Corporate Director Mar 12, 2020
Richard Campbell Individual Corporate Director Sep 1, 2015
Ciro Grassi Individual Corporate DirectorCeo Aug 29, 2021
W-2 Managing Employee Nov 18, 2019

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786579200000",
    "number": "1033299862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2",
            "address_2": "783 WINCHESTER ST",
            "city": "PAW PAW",
            "state": "WV",
            "postal_code": "254340002",
            "telephone_number": "304-947-5500",
            "fax_number": "304-947-5563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "783 WINCHESTER ST",
            "city": "PAW PAW",
            "state": "WV",
            "postal_code": "254340002",
            "telephone_number": "304-947-5500",
            "fax_number": "304-947-5563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAINEER COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2026-08-13",
        "certification_date": "2026-08-13",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-947-5500",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMC",
            "identifier": "CC5660",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0035343000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Paw Paw, WV

Sources for this page

Verify at the official NPI Registry.