NPIMap

Organization Active NPI

Baymark Health Services of West Virginia, Inc.

Doing business as MedMark Treatment Centers Morgantown

  • Addiction Medicine (Family Medicine) Physician
  • Morgantown, WV
National Provider Identifier
1255047759
Registry record updated Jul 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X
Legal business name
BAYMARK HEALTH SERVICES OF WEST VIRGINIA, INC.
Doing business as
MedMark Treatment Centers Morgantown
Practice address
53 Don Knotts Blvd
Morgantown, WV 26508-6838
Phone
(304) 284-0025
Fax
(304) 284-0031
NPI assigned
Jan 27, 2023
Last updated
Jul 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2024

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

Authorized official

Name
Bruce Jarvie
Title
VP, Treasurer
Phone
(214) 379-3300

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X NU
Mental Health Counselor 101YM0800X NU
Professional Counselor 101YP2500X NU
Addiction (Substance Use Disorder) Registered Nurse 163WA0400X NU
Licensed Practical Nurse 164W00000X NU
Addiction Medicine (Family Medicine) Physician 207QA0401X NU Primary
Addiction Medicine (Internal Medicine) Physician 207RA0401X NU
Peer Specialist 175T00000X NU

Addresses

Primary practice location

53 Don Knotts Blvd
Morgantown, WV 26508-6838

Mailing address

1720 Lakepointe Dr Ste 117
Lewisville, TX 75057-6425
Phone (469) 470-4779

Other names 1

  • MedMark Treatment Centers Morgantown Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Baymark Health4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1674777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722211200000",
    "number": "1255047759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 LAKEPOINTE DR STE 117",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750576425",
            "telephone_number": "469-470-4779",
            "fax_number": "214-481-7740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 DON KNOTTS BLVD",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265086838",
            "telephone_number": "304-284-0025",
            "fax_number": "304-284-0031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYMARK HEALTH SERVICES OF WEST VIRGINIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-27",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A",
        "authorized_official_last_name": "JARVIE",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "VP, TREASURER",
        "authorized_official_telephone_number": "214-379-3300"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "163WA0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MedMark Treatment Centers Morgantown",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MedMark Treatment Centers Morgantown",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Morgantown, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; 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.