NPIMap

Organization Active NPI

E. a. Hawse Health Center, Inc.

  • Community Health Clinic/Center
  • Petersburg, WV
National Provider Identifier
1124508171
Registry record updated Aug 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
E. A. HAWSE HEALTH CENTER, INC.
Practice address
333 Rig St
Petersburg, WV 26847-1644
Phone
(304) 257-1110
Fax
(304) 897-6216
NPI assigned
Aug 20, 2018
Last updated
Aug 20, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2018

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

Authorized official

Name
Brenda Leigh Thompson
Title
Administrative Assistant
Phone
(304) 897-5915

Specialties & licenses 1

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

Addresses

Primary practice location

333 Rig St
Petersburg, WV 26847-1644

Mailing address

PO Box 97
Baker, WV 26801-0097
Phone (304) 897-5915

Other identifiers 1

IdentifierTypeStateIssuer
1033347414OtherWVGROVE STREET HEALTH CENTER NPI

Other names 1

  • Petersburg Elementary School Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200327002174 WV Part A Provider - Federally Qualified Health Center (FQHC) 6204728041 Practice locations: Petersburg, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124508171. Details of each certification follow.

Federally qualified health center certification: CCN 581801

Legal name
E. A. HAWSE HEALTH CENTER, INC.
Doing business as
PETERSBURG ELEMENTARY SCHOOL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 29, 2020
Last certification
Jan 29, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 10, 1980 in WV
Enrollment address
333 Rig St
Petersburg, WV 26847-1644

Other NPIs with the same Medicare PAC ID 17

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 17

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
51D2196033Petersburg Elementary School333 Rig Street, Petersburg, WV 26847Provider-performed microscopyOct 13, 2026

National Provider Directory

National Provider Directory
Tax ID family
Ea Hawse Health Center24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

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

View all 23

Locations

111 S Grove St
Ste 1
Petersburg, WV 26847
Phone (304) 257-2451

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Celesta Miller Individual Corporate OfficerSecretary Feb 1, 2020
John Hunter Williams Individual Corporate Director Nov 1, 2025
Joann Kuhn Individual Corporate Director Nov 1, 2019
Michael Funkhouser Individual Corporate OfficerBoard President Sep 1, 2022
Imogen Helsley Individual Corporate Director Feb 1, 2023
Ralph Fitzwater Individual Corporate Director Dec 1, 2019
Christopher Hahn Individual Operational/Managerial ControlCfo Mar 1, 2025
John Treadway Individual Corporate Director Feb 1, 2023
Cheryl L Sherman Individual Operational/Managerial ControlBilling Supervisor Oct 1, 2018
Stacey Heavner Individual Corporate Director Dec 1, 2009
Kristopher Kerr Individual Corporate Director Dec 1, 2016
David Mayfield Individual Corporate OfficerTreasurer Jun 1, 2020
Melissa Thompson Individual Contracted Managing EmployeeAd; Jan 1, 2019
Corporate OfficerCeo Jan 1, 2019
Operational/Managerial ControlCeo Dec 1, 2019
Tracey Ratliff Individual Corporate Director Sep 1, 2018
Regina Whetzel Individual Corporate OfficerVice President Nov 1, 2011
Corporate Director Nov 1, 2011

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": "1534723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534723200000",
    "number": "1124508171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 97",
            "city": "BAKER",
            "state": "WV",
            "postal_code": "268010097",
            "telephone_number": "304-897-5915",
            "fax_number": "304-897-6216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 RIG ST",
            "city": "PETERSBURG",
            "state": "WV",
            "postal_code": "268471644",
            "telephone_number": "304-257-1110",
            "fax_number": "304-897-6216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "E. A. HAWSE HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-20",
        "last_updated": "2018-08-20",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "LEIGH",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "304-897-5915"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROVE STREET HEALTH CENTER NPI",
            "identifier": "1033347414",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Petersburg Elementary School",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Petersburg Elementary School",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Petersburg, WV

Sources for this page

Verify at the official NPI Registry.