Community Health Association
Organization Active NPI Clinic/Center · Ripley, WV
NPI 1134417975 · NPPES record last updated Jun 20, 2018
Key facts
- NPI
- 1134417975
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- License
- 52 (WV)
- Legal business name
- COMMUNITY HEALTH ASSOCIATION
- Practice address
- 200 Academy Drive
Ripley, WV 25271-9101 - Phone
- (304) 372-2731
- Fax
- (304) 372-2749
- NPI assigned
- Jul 14, 2011
- Organization subpart
- No
Authorized official
- Name
- Mrs. Stephanie L McCoy
- Title
- President/Ceo
- Phone
- (304) 373-1475
Other NPIs on the same Medicare enrollment 6
Practitioners 8
-
Staci D Cummings, APRN
-
Angel Victoria Ritchie, FNP-BC
-
Jennifer C. Simon, CFNP
-
Nicole Leigh Niese, PA-C
-
Jay D Wilson, PA-C
-
Paul Burke, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 51D2032558 | Jackson General Clinic | Certificate of waiver | Nov 9, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031219000784 | WV | Part B Supplier - Clinic/Group Practice | 1759291313 |
Receives reassigned benefits from 135 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Ripley, WV; Ravenswood, WV |
National Provider Directory
Locations
186 Pinnell St
Ripley, WV 25271
Phone (304) 373-1546
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | 52 | WV | Yes |
Addresses
Primary practice location
200 Academy Drive
Ripley, WV 25271-9101
Mailing address
PO Box 720
Ripley, WV 25271-0720
Phone (304) 372-2731
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134417976 | Other | WV | NPI |
| 3810021320 | Medicaid | WV |
Other names
- Jackson General Clinic
Other providers in Ripley, WV
- Sabrina Cogar
- Fred Thomas Combs Jr.
- Community Health Association
- Community Health Association
- Community Health Association
- Community Health Association
- Community Health Association
- Community Health Association
- Community Health Association
- Community Health Association
All providers in Ripley, WV · 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 Jun 20, 2018. 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.
- 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.