NPIMap

Organization Active NPI

Monroe Health Center-Peterstown Lab

  • Clinical Medical Laboratory
  • Peterstown, WV
National Provider Identifier
1407072408
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
MONROE HEALTH CENTER-PETERSTOWN LAB
Practice address
591 US Highway 219
Peterstown, WV 24963
Phone
(304) 753-4336
Fax
(304) 753-4097
NPI assigned
Apr 18, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Roger Brady
Title
Ceo
Phone
(304) 772-3064

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X WV Primary

Addresses

Primary practice location

591 US Highway 219
Peterstown, WV 24963

Mailing address

200 Health Center Drive
Union, WV 24983
Phone (304) 772-3064

Other identifiers 1

IdentifierTypeStateIssuer
3810001366MedicaidWV

National Provider Directory

National Provider Directory
Tax ID family
Monroe County Health Center Board of Trustees11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407072408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HEALTH CENTER DRIVE",
            "city": "UNION",
            "state": "WV",
            "postal_code": "24983",
            "telephone_number": "304-772-3064",
            "fax_number": "304-772-3296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "591 US HIGHWAY 219",
            "city": "PETERSTOWN",
            "state": "WV",
            "postal_code": "24963",
            "telephone_number": "304-753-4336",
            "fax_number": "304-753-4097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONROE HEALTH CENTER-PETERSTOWN LAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRADY",
        "authorized_official_first_name": "ROGER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-772-3064"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "WV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810001366",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peterstown, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.