NPIMap

Organization Active NPI

Community Health Systems, Inc.

Doing business as AccessHealth Fairdale School-Based Clinic

  • Family Medicine Physician
  • Fairdale, WV
National Provider Identifier
1073230504
Registry record updated Oct 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COMMUNITY HEALTH SYSTEMS, INC.
Doing business as
AccessHealth Fairdale School-Based Clinic
Practice address
772 Bolt Road
Fairdale, WV 25839
Phone
(304) 719-8949
Fax
(304) 934-7835
NPI assigned
Oct 25, 2022
Last updated
Oct 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2022

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

Authorized official

Name
Charles Hunt
Title
Ceo
Phone
(304) 252-8324

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

772 Bolt Road
Fairdale, WV 25839

Mailing address

252 Rural Acres Dr
Beckley, WV 25801-3503
Phone (304) 252-8324

Other names 1

  • AccessHealth Fairdale School-Based Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240628002496 WV Part A Provider - Federally Qualified Health Center (FQHC) 6608785795 Practice locations: Fairdale, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073230504. Details of each certification follow.

Federally qualified health center certification: CCN 581064

Legal name
COMMUNITY HEALTH SYSTEMS INC
Doing business as
ACCESSHEALTH FAIRDALE ELEMENTARY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 10, 2025
Last certification
Apr 10, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
772 Bolt Rd
Fairdale, WV 25839-1145

National Provider Directory

National Provider Directory
Tax ID family
Access Health Clear Fork44 organizations share this tax ID, including this one

Other organizations with this tax ID 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Carl Bowman Individual Corporate Officer Jun 1, 2015
Maura Johnson Individual Corporate Officer Jun 1, 2013
Kimberly Bryant Individual Corporate Officer Jun 6, 2007
Carolyn Dilorenzo Individual Corporate Officer Aug 1, 2007
Charles Hunt Individual W-2 Managing EmployeeCeo Apr 17, 2000

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Access HealthWelch, WV, CCN 511151 Federally qualified health center Operational/Managerial Control Aug 25, 2017
Community Health Systems IncBeckley, WV, CCN 511159 Federally qualified health center Operational/Managerial Control Oct 1, 2018
AccesshealthBeckley, WV, CCN 511175 Federally qualified health center Operational/Managerial Control Aug 1, 2019
Accesshealth Daniels Elementary SchoolDaniels, WV, CCN 511180 Federally qualified health center Operational/Managerial Control Apr 17, 2000
Community Health Systems IncBeckley, WV, CCN 581840 Federally qualified health center Operational/Managerial Control Apr 17, 2000
Accesshealth Stratton ElementaryBeckley, WV, CCN 581072 Federally qualified health center Operational/Managerial Control Oct 31, 2023

NPI Registry JSON

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

{
    "created_epoch": "1666656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666656000000",
    "number": "1073230504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "252 RURAL ACRES DR",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "258013503",
            "telephone_number": "304-252-8324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "772 BOLT ROAD",
            "city": "FAIRDALE",
            "state": "WV",
            "postal_code": "25839",
            "telephone_number": "304-719-8949",
            "fax_number": "304-934-7835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH SYSTEMS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-25",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-20",
        "status": "A",
        "authorized_official_last_name": "HUNT",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-252-8324"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AccessHealth Fairdale School-Based Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairdale, WV

Sources for this page

Verify at the official NPI Registry.