NPIMap

Organization Active NPI

Healthy Habits Wellness Center Lab

  • Clinical Medical Laboratory
  • Logan, WV
National Provider Identifier
1215195466
Registry record updated May 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
HEALTHY HABITS WELLNESS CENTER LAB
Practice address
140 Stollings Ave
Ste 3
Logan, WV 25601-4035
Phone
(304) 752-4594
Fax
(304) 752-5629
NPI assigned
May 23, 2008
Organization subpart
Yes
Parent organization
HEALTHY HABITS WELLNESS CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 23, 2008

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

Authorized official

Name
Dr. Jon M Miller, DONPI 1841245339
Title
President
Phone
(304) 752-4594

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

140 Stollings Ave
Ste 3
Logan, WV 25601-4035

Mailing address

140 Stollings Ave
Ste 3
Logan, WV 25601-4035
Phone (304) 752-4594

Other identifiers 1

IdentifierTypeStateIssuer
3810005483MedicaidWV

National Provider Directory

National Provider Directory
Tax ID family
Healthy Habits Wellness Ctr2 organizations share this tax ID, including this one
Part of
Healthy Habits Wellness Ctr

Other organizations with this tax ID 1

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

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 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1211500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211500800000",
    "number": "1215195466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 STOLLINGS AVE",
            "address_2": "STE 3",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256014035",
            "telephone_number": "304-752-4594",
            "fax_number": "304-752-5629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 STOLLINGS AVE",
            "address_2": "STE 3",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256014035",
            "telephone_number": "304-752-4594",
            "fax_number": "304-752-5629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHY HABITS WELLNESS CENTER LAB",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HEALTHY HABITS WELLNESS CENTER",
        "enumeration_date": "2008-05-23",
        "last_updated": "2008-05-23",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-752-4594",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810005483",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Logan, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2008; 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.