NPIMap

Organization Active NPI

Cabin Creek Health Center, Inc.

Doing business as Cabin Creek Health Center, Inc. at KCHD

  • Community Health Clinic/Center
  • Charleston, WV
National Provider Identifier
1063932929
Registry record updated Jun 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
CABIN CREEK HEALTH CENTER, INC.
Doing business as
Cabin Creek Health Center, Inc. at KCHD
Practice address
108 Lee St E
Charleston, WV 25301-1506
Phone
(304) 734-2040
Fax
(304) 734-2047
NPI assigned
Jun 22, 2017
Last updated
Jun 22, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
CABIN CREEK HEALTH CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 22, 2017

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

Authorized official

Name
Jennifer Russell
Title
Administrative Assistant
Phone
(304) 734-2040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

108 Lee St E
Charleston, WV 25301-1506

Mailing address

PO Box 70
Dawes, WV 25054-0070
Phone (304) 734-2040

Other names 1

  • Cabin Creek Health Center, Inc. at KCHD Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130905000096 WV Part B Supplier - Clinic/Group Practice 2466431101 Receives reassigned benefits from 88 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clendenin, WV; Dawes, WV; Charleston, WV; Belle, WV

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Part of
Cabin Creek Health Center Pharmacy

Locations

108 Lee St E
Charleston, WV 25301
Phone (304) 348-6494

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1498089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1498089600000",
    "number": "1063932929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70",
            "city": "DAWES",
            "state": "WV",
            "postal_code": "250540070",
            "telephone_number": "304-734-2040",
            "fax_number": "304-734-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 LEE ST E",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253011506",
            "telephone_number": "304-734-2040",
            "fax_number": "304-734-2047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CABIN CREEK HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CABIN CREEK HEALTH CENTER, INC.",
        "enumeration_date": "2017-06-22",
        "last_updated": "2017-06-22",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "304-734-2040"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cabin Creek Health Center, Inc. at KCHD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.