NPIMap

Organization Active NPI

Polk County Community Health & Wellness Center, Inc.

Doing business as Polk Wellness Center

  • Medical Physician Assistant
  • Columbus, NC
National Provider Identifier
1194030403
Registry record updated Aug 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Legal business name
POLK COUNTY COMMUNITY HEALTH & WELLNESS CENTER, INC.
Doing business as
Polk Wellness Center
Practice address
801 W Mills St
Columbus, NC 28722-8494
Phone
(828) 894-2222
Fax
(828) 894-2229
NPI assigned
Aug 11, 2010
Last updated
Aug 11, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2010

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

Authorized official

Name
Mary Jo Stark
Title
Office Manager
Phone
(828) 894-2222

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363A00000X
Medical Physician AssistantGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363AM0700X Primary

Addresses

Primary practice location

801 W Mills St
Columbus, NC 28722-8494

Mailing address

PO Box 130
Columbus, NC 28722-0130
Phone (828) 894-2222

Other names 1

  • Polk Wellness Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Polk County Community Health and Wellness Center Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

801 W Mills St
Columbus, NC 28722
Phone (828) 817-0723

Practitioners & affiliated clinicians

Practitioners 11

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": "1281484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281484800000",
    "number": "1194030403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "COLUMBUS",
            "state": "NC",
            "postal_code": "287220130",
            "telephone_number": "828-894-2222",
            "fax_number": "828-894-2229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 W MILLS ST",
            "city": "COLUMBUS",
            "state": "NC",
            "postal_code": "287228494",
            "telephone_number": "828-894-2222",
            "fax_number": "828-894-2229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLK COUNTY COMMUNITY HEALTH & WELLNESS CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-11",
        "last_updated": "2010-08-11",
        "status": "A",
        "authorized_official_last_name": "STARK",
        "authorized_official_first_name": "MARY JO",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "828-894-2222"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Polk Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbus, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.