Proactive MD WV Corporation

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

PROACTIVE MD WV CORPORATION

Doing business as

Proactive MD
Union Health and Wellness Center

Practice address

269 Staunton Avenue SW
Suite 100
S. Charleston, WV 25303

Phone

(304) 768-0321

Fax

(864) 990-3834

NPI assigned

Jul 3, 2024

Organization subpart

No

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

Authorized official

Name

Mark Kemble, MD

Title

Cmo

Phone

(864) 501-0754

Specialties & licenses 1

Addresses

Other names 2

• Proactive MD Doing business as
• Union Health and Wellness Center Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1719964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743638400000",
    "number": "1275379810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 ALLAWOOD CT",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296816207",
            "telephone_number": "864-501-0754",
            "fax_number": "864-990-3834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "269 STAUNTON AVENUE SW",
            "address_2": "SUITE 100",
            "city": "S. CHARLESTON",
            "state": "WV",
            "postal_code": "25303",
            "telephone_number": "304-768-0321",
            "fax_number": "864-990-3834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE MD WV CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-03",
        "last_updated": "2025-04-03",
        "certification_date": "2025-04-03",
        "status": "A",
        "authorized_official_last_name": "KEMBLE",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "864-501-0754",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proactive MD",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Union Health and Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Primary Care Clinic/Center in S. Charleston, WV
• Providers in S. Charleston, WV by specialty
• Primary Care Clinic/Center in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.