NPIMap

Organization Active NPI

Wvupc-Kanawha Valley Family Practice

  • Family Medicine Physician
  • S Charleston, WV
National Provider Identifier
1114170693
Registry record updated Oct 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WVUPC-KANAWHA VALLEY FAMILY PRACTICE
Practice address
401 Division St
Suite 205
S Charleston, WV 25309-1455
Phone
(304) 768-3941
NPI assigned
Oct 29, 2008
Organization subpart
Yes
Parent organization
WEST VIRGINIA UNIVERSITY MEDICAL CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 29, 2008

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

Authorized official

Name
Robyn M McDaniel
Title
Provider Relations Supervisor
Phone
(304) 293-5033

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

401 Division St
Suite 205
S Charleston, WV 25309-1455

Mailing address

PO Box 7000
Morgantown, WV 26507-7000
Phone (304) 293-7401

Other identifiers 1

IdentifierTypeStateIssuer
4002106000MedicaidWV

National Provider Directory

National Provider Directory
Tax ID family
Wvu Physicians of Charl21 organizations share this tax ID, including this one
Part of
Wvu Physicians of Charl

Other organizations with this tax ID 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1225238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225238400000",
    "number": "1114170693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7000",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265077000",
            "telephone_number": "304-293-7401",
            "fax_number": "304-293-6963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 DIVISION ST",
            "address_2": "SUITE 205",
            "city": "S CHARLESTON",
            "state": "WV",
            "postal_code": "253091455",
            "telephone_number": "304-768-3941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WVUPC-KANAWHA VALLEY FAMILY PRACTICE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WEST VIRGINIA UNIVERSITY MEDICAL CORPORATION",
        "enumeration_date": "2008-10-29",
        "last_updated": "2008-10-29",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL",
        "authorized_official_first_name": "ROBYN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PROVIDER RELATIONS SUPERVISOR",
        "authorized_official_telephone_number": "304-293-5033"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4002106000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in S Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2008; 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.