Clendenin Health Center Lab
Organization Active NPI Federally Qualified Health Center (FQHC) · Clendenin, WV
NPI 1407259062 · NPPES record last updated Jul 30, 2025
Key facts
- NPI
- 1407259062
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- CLENDENIN HEALTH CENTER LAB
- Practice address
- 107 Koontz Ave Ste 200
Clendenin, WV 25045-9581 - Phone
- (304) 734-2040
- Fax
- (301) 734-2047
- NPI assigned
- Sep 26, 2014
- Organization subpart
- No
Authorized official
- Name
- Jennifer Russell
- Title
- Administrative Assistant
- Phone
- (304) 734-2040
Corporate family (same tax ID) 12
National Provider Directory
- Tax ID family
- Kanawha City Health Center Pharmacy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
107 Koontz Ave Ste 200
Clendenin, WV 25045-9581
Mailing address
PO Box 70
Dawes, WV 25054-0070
Phone (304) 734-2040
Other providers in Clendenin, WV
- Aaron James Beighle
- Michael Ross Brumage
- Tanaya Burdette
- Cabin Creek Health Center, Inc.
- Amanda Marie Canipe
- Clendenin Health Center Pharmacy at Riverview
- Clendenin Pharmacy Inc
- Tammie Ann Cummings
- Cynthia Derringer
- Douglas Joseph Donovall Jr.
All providers in Clendenin, WV · Federally Qualified Health Center (FQHC) in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 30, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.