NPIMap

Organization Active NPI

Williamson Memorial, Inc.

  • Emergency Medicine Physician
  • Williamson, WV
National Provider Identifier
1174345243
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
WILLIAMSON MEMORIAL, INC.
Practice address
859 Alderson St
Williamson, WV 25661-3215
Phone
(304) 235-2500
Fax
(304) 209-7094
NPI assigned
Oct 29, 2024
Last updated
Oct 29, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
WILLIAMSON MEMORIAL, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

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

Authorized official

Name
David Jewell
Title
Cfo
Phone
(304) 236-5902

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU Primary

Addresses

Primary practice location

859 Alderson St
Williamson, WV 25661-3215

Mailing address

PO Box 1038
Williamson, WV 25661-1038
Phone (606) 369-5753

Other names 1

  • WM Professional Group Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201124002158 WV Part B Supplier - Clinic/Group Practice 7618388554 Receives reassigned benefits from 16 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Williamson, WV

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
Williamson Memorial Inc

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 12

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": "1730160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730160000000",
    "number": "1174345243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1038",
            "city": "WILLIAMSON",
            "state": "WV",
            "postal_code": "256611038",
            "telephone_number": "606-369-5753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "859 ALDERSON ST",
            "city": "WILLIAMSON",
            "state": "WV",
            "postal_code": "256613215",
            "telephone_number": "304-235-2500",
            "fax_number": "304-209-7094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAMSON MEMORIAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILLIAMSON MEMORIAL, INC",
        "enumeration_date": "2024-10-29",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A",
        "authorized_official_last_name": "JEWELL",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "304-236-5902"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WM Professional Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Williamson, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 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.