NPIMap

Organization Active NPI

Midtowne Family Practice PLLC

  • Family Medicine Physician
  • Princeton, WV
National Provider Identifier
1154436004
Registry record updated Apr 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1040 Issued in WV
Legal business name
MIDTOWNE FAMILY PRACTICE PLLC
Practice address
403 12TH Street Ext
Princeton, WV 24740-2300
Phone
(304) 431-9998
Fax
(304) 425-0782
NPI assigned
Aug 20, 2006
Last updated
Apr 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2024

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

Authorized official

Name
Pamela P. Faulkner, DONPI 1003871401
Title
Physician/Owner
Phone
(304) 431-7100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 1040 WV Primary

Addresses

Primary practice location

403 12TH Street Ext
Princeton, WV 24740-2300

Mailing address

PO Box 1030
Princeton, WV 24740-1030
Phone (304) 431-7100

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100902000030 WV Part B Supplier - Clinic/Group Practice 8426172115 Receives reassigned benefits from 1 practitioner
Practice locations: Princeton, WV

National Provider Directory

National Provider Directory

Locations

403 12th Street Ext
Princeton, WV 24740
Phone (304) 431-3333

Practitioners & affiliated clinicians

Practitioners 6

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": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713139200000",
    "number": "1154436004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1030",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "247401030",
            "telephone_number": "304-431-7100",
            "fax_number": "304-431-7112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 12TH STREET EXT",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "247402300",
            "telephone_number": "304-431-9998",
            "fax_number": "304-425-0782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDTOWNE FAMILY PRACTICE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A",
        "authorized_official_last_name": "FAULKNER",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "304-431-7100",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "1040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Princeton, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.