NPIMap

Organization Active NPI

Mountaineer Family Medicine, Inc.

  • Family Medicine Physician
  • Welch, WV
National Provider Identifier
1346080702
Registry record updated May 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MOUNTAINEER FAMILY MEDICINE, INC.
Practice address
794 Virginia Ave
Welch, WV 24801-2339
Phone
(681) 201-2064
NPI assigned
May 31, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2024

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

Authorized official

Name
Victoria Warner
Title
Billing Director
Phone
(681) 264-4986

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

794 Virginia Ave
Welch, WV 24801-2339

Mailing address

5240 Maccorkle Ave SE
Charleston, WV 25304-2122
Phone (681) 264-4986

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
51D2275064Mountaineer Family Medicine - Welch Office794 Virginia Avenue, Welch, WV 24801Certificate of waiverJan 16, 2027

National Provider Directory

National Provider Directory
Tax ID family
Mountaineer Family Medicine Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

794 Virginia Ave
Welch, WV 24801
Phone (304) 436-8435

NPI Registry JSON

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

{
    "created_epoch": "1717113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717113600000",
    "number": "1346080702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5240 MACCORKLE AVE SE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253042122",
            "telephone_number": "681-264-4986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "794 VIRGINIA AVE",
            "city": "WELCH",
            "state": "WV",
            "postal_code": "248012339",
            "telephone_number": "681-201-2064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAINEER FAMILY MEDICINE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-31",
        "last_updated": "2024-05-31",
        "certification_date": "2024-05-31",
        "status": "A",
        "authorized_official_last_name": "WARNER",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_title_or_position": "BILLING DIRECTOR",
        "authorized_official_telephone_number": "681-264-4986"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Welch, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2024; 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.