St Charles Health Council Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Appalachia, VA
NPI 1194845552 · NPPES record last updated Jul 5, 2019
Key facts
- NPI
- 1194845552
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- ST CHARLES HEALTH COUNCIL INC
- Practice address
- 536 E Main St
Appalachia, VA 24216 - Phone
- (276) 565-2760
- Fax
- (276) 546-9706
- NPI assigned
- Mar 30, 2007
- Organization subpart
- No
Authorized official
- Name
- Malcolm Perdue
- Title
- Ceo
- Phone
- (276) 546-5310
Other NPIs on the same Medicare enrollment 11
Other NPIs with the same Medicare PAC ID 11
Practitioners 12
-
Katherine Burner Barnett, LCSW
-
Crystal E Burke, LCSW
-
Melissa Nicole Keene, M.D.
-
Angelia McClanahan, LCSW
-
Paulina Rios, MD
-
Wayne A Vanzee, MD
-
Joshua A Yeary, DO
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 49D1056456 | Appalachia Family Health Center | Provider-performed microscopy | Jul 16, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VA
Federally qualified health center certification: CCN 491867
- Legal name
- ST. CHARLES HEALTH COUNCIL INC
- Doing business as
- STONE MOUNTAIN HEALTH SERVICES
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 5, 2006
- Last certification
- Oct 5, 2006
- Ownership / control type
- Non-profit – church related
- Organization structure
- Corporation · Non-profit
- Incorporated
- Aug 9, 1973 in VA
- Enrollment address
- 536 E Main St
Appalachia, VA 24216-1500
All disclosed owners & managing parties 20
| Name | Role | Since | Share |
|---|---|---|---|
| Betty Rose |
Corporate Director |
Jun 1, 2021 | |
| Rufus C Hay |
Corporate Director | Jul 1, 2006 | |
| Joyce Williams |
Corporate Director |
Jun 1, 2021 | |
| Malcolm L Perdue |
Corporate Director |
Jul 1, 2006 | 100% |
| Violet J Martin |
Corporate Director | Jul 1, 2006 | |
| Nancy S Gibson |
Corporate Director |
Jun 1, 2021 | |
| Douglas McConnell |
Corporate Director |
Jun 1, 2021 | |
| Homer Wayne Fields |
Corporate Director |
Jun 1, 2021 | |
| Rebecca Johnson |
Corporate Director |
Jun 1, 2021 | |
| Mary K Edwards |
Corporate Director | Jul 1, 2006 | |
| Saundra Jones |
W-2 Managing Employee | Jul 1, 2006 | |
| Nancy Mann |
Corporate Director |
Jun 1, 2021 | |
| Janice Harber |
Corporate Director |
Jun 1, 2021 | |
| Sherry Lowe |
Corporate Director |
Jun 1, 2021 | |
| Delores Anne Pennington |
Corporate Director |
Jun 1, 2021 | |
| Gregory D Edwards |
Corporate Director | Jul 1, 2006 | |
| Deborah Bostic |
Corporate Director |
Jun 1, 2021 | |
| James Oquinn |
Corporate Director |
Jun 1, 2021 | |
| Kathy Turner |
Corporate Director |
Jun 1, 2021 | |
| Gary Bush |
Corporate Director |
Jun 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040209001103 | VA | Part B Supplier - Clinic/Group Practice | 0244124584 |
Receives reassigned benefits from 26 practitioners 10 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Honaker, VA; Vansant, VA; St Paul, VA; St Charles, VA; Saint Charles, VA; Jonesville, VA; Hurley, VA; Haysi, VA… |
| O20060720000152 | VA | Part a Provider - Federally Qualified Health Center (FQHC) | 0244124584 |
1 other NPI on this enrollment Practice locations: Appalachia, VA |
National Provider Directory
Locations
536 E Main St
Appalachia, VA 24216
Phone (276) 565-2760
1446 Dr Thomas Walker Rd
Ewing, VA 24248
Phone (276) 445-4826
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
536 E Main St
Appalachia, VA 24216
Mailing address
276 Fieldstone Dr
Jonesville, VA 24263-1215
Phone (276) 546-5310
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010376033 | Medicaid | VA |
Other names
- Appalachia Family Health Center
Other providers in Appalachia, VA
- Lisa Frankie Muncy
- David Roberts
- Southwest Home Carellc.
- Southwest Women'S Health Services of Virginia
- Southwest Women'S Health Services of Virginia, PLLC
All providers in Appalachia, VA · Federally Qualified Health Center (FQHC) in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 5, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.