Boone Memorial Hospital, Inc
Organization Active NPI Rural Health Clinic/Center · Danville, WV
NPI 1124617535 · NPPES record last updated Oct 23, 2023
Key facts
- NPI
- 1124617535
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- BOONE MEMORIAL HOSPITAL, INC
- Practice address
- 300 4TH Street
Danville, WV 25053 - Phone
- (304) 369-8839
- NPI assigned
- Jan 12, 2021
- Organization subpart
- Yes
- Parent organization (as reported)
- BOONE MEMORIAL HOSPITAL, INC.
Authorized official
- Name
- Virgil Underwood
- Title
- Ceo
- Phone
- (304) 369-1230
Owned or controlled facilities with NPI records 5
Other NPIs with the same Medicare PAC ID 7
Corporate family (same tax ID) 10
Member of 1
Related certifications (CCN) 1
Practitioners 85
-
Kenneth Adkins, DO
-
Stephen Albright, PA
-
Loretta Marie Brown, FNP
-
Andrew D Bryant, D.O
-
Shane Cook, M.D.
-
John A Deluca, M.D.
-
Angela Dawn Glick, LCP
-
Brittany D Griffith, FNP-BC
-
Kelly Ann Hager, MD
-
Melanie Lea Harper-Allen, RN/NP
-
Casey Shannon Hatfield, PA-C
-
Kevin Dale Hill, MPAS, PA-C
-
Frank C Lucente, M.D.
-
Amanda G Messer, FNP-BC
-
Leslie Michael Peterson, D.O.
-
Marylea Ruth Seacrist, APRN
-
Deborah L Townsley, APRN, RN
-
Seth Williams, MD
-
Robert Zickafoose, FNP-C
-
Jody Asbury, PA
-
Chad Edward Baisden, CRNA
-
Jimi L Baisden, CRNA
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 51D2174513 | Danville Clinic, the | Provider-performed microscopy | Nov 3, 2027 |
| 51D2188180 | Danville Clinic, the | Certificate of waiver | Jul 13, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
Rural health clinic certification: CCN 513432
- Legal name
- BOONE MEMORIAL HOSPITAL INC
- Doing business as
- BMH WALK-IN CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- May 2, 2023
- Last certification
- May 2, 2023
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Sep 16, 2010 in WV
- Enrollment address
- 173 State St
Madison, WV 25130-1139 - Related CCNs
- 511313
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Angela Christian |
Corporate Director |
Mar 1, 2023 | |
| W-2 Managing Employee |
Mar 1, 2023 | ||
| Douglas Cole Malcolm |
Corporate Director |
Mar 1, 2023 | |
| W-2 Managing Employee |
Mar 1, 2023 | ||
| Virgil L Underwood |
Corporate Director |
Mar 1, 2023 | |
| W-2 Managing Employee |
Mar 1, 2023 |
All facility ownership & control disclosures 5
| Facility | Type | Role | Since |
|---|---|---|---|
| Boone Memorial Hospital Inc |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2012 |
| Boone Memorial Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2012 |
| BMH Family Medical Center |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2012 |
| BMH Medical Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2012 |
| BMH Comfort Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Aug 25, 2022 Aug 28, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230512002033 | WV | Part a Provider - Rural Health Clinic | 3375433352 | Practice locations: Madison, WV |
National Provider Directory
- Tax ID family
- Boone County Hospital
- Part of
- Boone County Hospital
Locations
173 State St
Madison, WV 25130
Phone (304) 369-1230
701 Madison Ave
Madison, WV 25130
Phone (304) 369-1230
716 Madison Ave
Madison, WV 25130
Phone (304) 369-1230
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
300 4TH Street
Danville, WV 25053
Mailing address
701 Madison Ave
Madison, WV 25130-1699
Phone (304) 369-2932
Other practice location 1
173 State St
Madison, WV 25130-1139
Phone (304) 369-1230 ext. 6602
Other names
- BMH Danville Clinic
- BMH Walk-In Clinic
Other providers in Danville, WV
- Boone County Community Organization
- Boone County Community Organization
- Boone County Health Department
- Boone County Health Dept.
- Boone Memorial Homecare, LLC
- Cassandra Booth
- Kara Booth
- Kayley Bowe
- Kyerston Bowman
- Megan Lynn Boyd
All providers in Danville, WV · Rural Health Clinic/Center in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 23, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.