NPIMap

Organization Active NPI

Logan-Mingo Area Mental Health, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Logan, WV
National Provider Identifier
1346395035
Registry record updated Jan 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
11 Issued in WV
Legal business name
LOGAN-MINGO AREA MENTAL HEALTH, INC.
Practice address
174 Lmah Center Rd
Logan, WV 25601-4058
Phone
(304) 792-7130
NPI assigned
Jan 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2020

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

Authorized official

Name
Angela Lynn Robertson
Title
Benefits Coordinator
Phone
(304) 792-7130

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 11 WV Primary

Addresses

Primary practice location

174 Lmah Center Rd
Logan, WV 25601-4058

Mailing address

PO Box 176
Logan, WV 25601-0176
Phone (304) 792-7130

Other identifiers 1

IdentifierTypeStateIssuer
0005460001MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050124000168 WV Part B Supplier - Clinic/Group Practice 0840240362 Receives reassigned benefits from 10 practitioners
1 other NPI on this enrollment
Practice locations: Logan, WV; Williamson, WV

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Logan Mingo Area Mental Health 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

174 Lmah Center Rd
Logan, WV 25601
Phone 3047927130 ext. 1027

Practitioners & affiliated clinicians

Practitioners 10

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": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580342400000",
    "number": "1346395035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 176",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256010176",
            "telephone_number": "304-792-7130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "174 LMAH CENTER RD",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256014058",
            "telephone_number": "304-792-7130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOGAN-MINGO AREA MENTAL HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2020-01-30",
        "certification_date": "2020-01-30",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "BENEFITS COORDINATOR",
        "authorized_official_telephone_number": "304-792-7130"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "WV",
            "license": "11",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005460001",
            "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 Jan 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.