NPIMap

Organization Active NPI

City of Sistersville

Doing business as St. Marys Express Care

  • Rural Health Clinic/Center
  • Saint Marys, WV
National Provider Identifier
1154722924
Registry record updated Oct 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CITY OF SISTERSVILLE
Doing business as
St. Marys Express Care
Practice address
201 2ND St
Saint Marys, WV 26170-1003
Phone
(681) 612-3501
Fax
(681) 612-3504
NPI assigned
Sep 11, 2014
Last updated
Oct 21, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
CITY OF SISTERSVILLEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 21, 2020

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

Authorized official

Name
Brandon W Chadock
Title
Ao
Phone
(304) 652-2611

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

201 2ND St
Saint Marys, WV 26170-1003

Mailing address

314 S Wells St
Sistersville, WV 26175-1098
Phone (304) 652-2611

Other names 1

  • St. Marys Express Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Tax ID family
Marietta Memorial Hospital of Tyler County Inc6 organizations share this tax ID, including this one
Part of
Sistersville General Hosp

Other organizations with this tax ID 5

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

Locations

305 Clay St
Sistersville, WV 26175
Phone (304) 447-2038

Ownership & related parties

Change-of-ownership history 1

DateEventCounterparty
Oct 1, 2020 Change of OwnershipThis provider was the seller St Marys Primary CareCCN 513421, WV, NPI 1437758034

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1410393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603238400000",
    "number": "1154722924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 S WELLS ST",
            "city": "SISTERSVILLE",
            "state": "WV",
            "postal_code": "261751098",
            "telephone_number": "304-652-2611",
            "fax_number": "304-652-1448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 2ND ST",
            "city": "SAINT MARYS",
            "state": "WV",
            "postal_code": "261701003",
            "telephone_number": "681-612-3501",
            "fax_number": "681-612-3504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF SISTERSVILLE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CITY OF SISTERSVILLE",
        "enumeration_date": "2014-09-11",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A",
        "authorized_official_last_name": "CHADOCK",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "AO",
        "authorized_official_telephone_number": "304-652-2611"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Marys Express Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Marys, WV

Sources for this page

Verify at the official NPI Registry.