NPIMap

Organization Active NPI

Clendenin Health Center Lab

  • Federally Qualified Health Center (FQHC)
  • Clendenin, WV
National Provider Identifier
1407259062
Registry record updated Jul 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 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
Last updated
Jul 30, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2025

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

Authorized official

Name
Jennifer Russell
Title
Administrative Assistant
Phone
(304) 734-2040

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

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

National Provider Directory

National Provider Directory
Tax ID family
Sissonville Health Center Pharmacy13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

107 Koontz Ave
Ste 200
Clendenin, WV 25045
Phone (304) 548-7272

NPI Registry JSON

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

{
    "created_epoch": "1411689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753833600000",
    "number": "1407259062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70",
            "city": "DAWES",
            "state": "WV",
            "postal_code": "250540070",
            "telephone_number": "304-734-2040",
            "fax_number": "304-734-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 KOONTZ AVE STE 200",
            "city": "CLENDENIN",
            "state": "WV",
            "postal_code": "250459581",
            "telephone_number": "304-734-2040",
            "fax_number": "301-734-2047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLENDENIN HEALTH CENTER LAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-26",
        "last_updated": "2025-07-30",
        "certification_date": "2025-07-30",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "304-734-2040"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clendenin, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2025; 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.