NPIMap

Organization Active NPI

Primary Care at Home of West Virginia, LLC

Doing business as Primary Care at Home of Charleston

  • Nurse Practitioner
  • Charleston, WV
National Provider Identifier
1386163392
Registry record updated Sep 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
PRIMARY CARE AT HOME OF WEST VIRGINIA, LLC
Doing business as
Primary Care at Home of Charleston
Practice address
414 Greenway Ave Ste 201
Charleston, WV 25309-1475
Phone
(304) 356-1356
Fax
(304) 885-7475
NPI assigned
Sep 12, 2017
Last updated
Sep 12, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2017

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

Authorized official

Name
Donald D. Stelly
Title
President
Phone
(337) 233-1307

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X Primary

Addresses

Primary practice location

414 Greenway Ave Ste 201
Charleston, WV 25309-1475

Mailing address

PO Box 51266
Lafayette, LA 70505-1266
Phone (337) 233-1307

Other names 1

  • Primary Care at Home of Charleston Doing business as

National Provider Directory

National Provider Directory

Locations

414 Greenway Ave
Ste 201
Charleston, WV 25309
Phone (304) 356-1356

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1505174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505174400000",
    "number": "1386163392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 51266",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705051266",
            "telephone_number": "337-233-1307",
            "fax_number": "337-233-5764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 GREENWAY AVE STE 201",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253091475",
            "telephone_number": "304-356-1356",
            "fax_number": "304-885-7475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE AT HOME OF WEST VIRGINIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-12",
        "last_updated": "2017-09-12",
        "status": "A",
        "authorized_official_last_name": "STELLY",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "337-233-1307"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Primary Care at Home of Charleston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2017; 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.