NPIMap

Organization Active NPI

Preston Taylor Community Health Centers, Incorporated

Doing business as Newburg Clinic

  • Federally Qualified Health Center (FQHC)
  • Newburg, WV
National Provider Identifier
1154439859
Registry record updated Dec 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PRESTON TAYLOR COMMUNITY HEALTH CENTERS, INCORPORATED
Doing business as
Newburg Clinic
Practice address
1321 N Mountaineer Highway
Newburg, WV 26410
Phone
(304) 892-2812
Fax
(304) 892-2814
NPI assigned
Aug 25, 2006
Last updated
Dec 9, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
PRESTON TAYLOR COMMUNITY HEALTH CENTERS, INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 9, 2024

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

Authorized official

Name
Elizabeth J Griffith
Title
Chief Executive Officer
Phone
(304) 265-0312

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1321 N Mountaineer Highway
Newburg, WV 26410

Mailing address

25 W Bluemont St
Grafton, WV 26354-1242
Phone (304) 265-0312

Other identifiers 1

IdentifierTypeStateIssuer
0035308000MedicaidWV

Other names 1

  • Newburg Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040209000039 WV Part B Supplier - Public Health/Welfare Agency 3072406438 Receives reassigned benefits from 20 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Newburg, WV; Thomas, WV; Rowlesburg, WV; Mount Storm, WV; Grafton, WV; Eglon, WV
O20090507000607 WV Part A Provider - Federally Qualified Health Center (FQHC) 3072406438 Practice locations: Newburg, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154439859. Details of each certification follow.

Federally qualified health center certification: CCN 511851

Legal name
PRESTON TAYLOR COMMUNITY HEALTH CENTERS, INCORPORATED
Doing business as
NEWBURG CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 1, 1995
Last certification
Jun 1, 1995
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Apr 1, 1987 in WV
Enrollment address
1321 N. Mountaineer Highway
Newburg, WV 26410

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
51D0909165Newburg Clinic1321 N Mountaineer Highway, Newburg, WV 26410Provider-performed microscopyNov 27, 2027

National Provider Directory

National Provider Directory
Part of
Community Eye Care

Locations

725 N Pike St
Grafton, WV 26354
Phone (304) 265-4909

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Vonda Reneman Individual Corporate DirectorBoard Member Jan 1, 2019
Karen Temple Individual Corporate DirectorBoard Member Apr 27, 2023
Mark Teets Individual Corporate DirectorBoard Member Oct 1, 2022
Victoria Hoffman Individual Corporate DirectorBoard Member Apr 27, 2023
Beverly J Snyder Individual W-2 Managing EmployeeExecutive Assistant Jan 23, 2014
Elizabeth June Griffith Individual Corporate OfficerCeo Jan 16, 2022 100%
W-2 Managing Employee Jan 16, 2022 100%
Doug Lyons Individual Corporate DirectorBoard Member Sep 21, 2009
Patrick a Nichols Individual Corporate DirectorBoard Member Sep 27, 2001
Tony Veltri Individual Corporate DirectorBoard Member Jun 1, 1986
Hunter B Mullens Individual Corporate DirectorBoard Member Jun 25, 1997

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Community Eye CareGrafton, WV, CCN 581043 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Mar 1, 2024
Mar 1, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 9

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": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733702400000",
    "number": "1154439859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 W BLUEMONT ST",
            "city": "GRAFTON",
            "state": "WV",
            "postal_code": "263541242",
            "telephone_number": "304-265-0312",
            "fax_number": "304-265-0314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1321 N MOUNTAINEER HIGHWAY",
            "city": "NEWBURG",
            "state": "WV",
            "postal_code": "26410",
            "telephone_number": "304-892-2812",
            "fax_number": "304-892-2814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTON TAYLOR COMMUNITY HEALTH CENTERS, INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRESTON TAYLOR COMMUNITY HEALTH CENTERS, INCORPORATED",
        "enumeration_date": "2006-08-25",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-06",
        "status": "A",
        "authorized_official_last_name": "GRIFFITH",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "304-265-0312"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0035308000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Newburg Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newburg, WV

Sources for this page

Verify at the official NPI Registry.