St Charles Health Council Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

ST CHARLES HEALTH COUNCIL INC

Doing business as

Stone Mountain Health Services

Practice address

2534 Mendota Road
Mendota, VA 24270

Phone

(276) 645-6710

NPI assigned

Apr 2, 2007

Last updated

Sep 4, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Malcolm Perdue

Title

Ceo

Phone

(276) 546-5310

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Stone Mountain Health Services Doing business as

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188864000000",
    "number": "1114047016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2534 MENDOTA ROAD",
            "city": "MENDOTA",
            "state": "VA",
            "postal_code": "24270",
            "telephone_number": "276-645-6710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2534 MENDOTA ROAD",
            "city": "MENDOTA",
            "state": "VA",
            "postal_code": "24270",
            "telephone_number": "276-645-6710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST CHARLES HEALTH COUNCIL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2007-09-04",
        "status": "A",
        "authorized_official_last_name": "PERDUE",
        "authorized_official_first_name": "MALCOLM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "276-546-5310"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114047016",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stone Mountain Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sue A Cressel, FNP
• Wellmont Physician Services Inc (Mendota Medical Center)

• Federally Qualified Health Center (FQHC) in Mendota, VA
• Providers in Mendota, VA by specialty
• Federally Qualified Health Center (FQHC) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2007; 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.