NPIMap

Organization Active NPI

Charleston Medical Center, Inc.

  • Community/Retail Pharmacy
  • Charleston, WV
National Provider Identifier
1457740433
Registry record updated May 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
MP0552417 Issued in WV
Legal business name
CHARLESTON MEDICAL CENTER, INC.
Practice address
3415 Maccorkle Ave SE Apt Eve
Charleston, WV 25304-1334
Phone
(304) 388-9700
Fax
(304) 388-9795
NPI assigned
Jan 14, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2018

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

Authorized official

Name
John Petts, PHARMD
Title
Director of Ambulatory Services, Ao
Phone
(304) 388-7400

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X MP0552417 WV Primary
Compounding Pharmacy 3336C0004X
Specialty Pharmacy 3336S0011X

Addresses

Primary practice location

3415 Maccorkle Ave SE Apt Eve
Charleston, WV 25304-1334

Mailing address

3415 Maccorkle Ave SE Apt Eve
Charleston, WV 25304-1334
Phone (304) 388-9700

Other identifiers 2

IdentifierTypeStateIssuer
2149740OtherPK
3910007155MedicaidWV

National Provider Directory

National Provider Directory
Tax ID family
Camc Physicians Health29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

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

View all 28

Locations

3415 Maccorkle Ave SE
Apt Eve
Charleston, WV 25304
Phone (304) 388-9700

NPI Registry JSON

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

{
    "created_epoch": "1421193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526515200000",
    "number": "1457740433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3415 MACCORKLE AVE SE APT EVE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041334",
            "telephone_number": "304-388-9700",
            "fax_number": "304-388-9795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3415 MACCORKLE AVE SE APT EVE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041334",
            "telephone_number": "304-388-9700",
            "fax_number": "304-388-9795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLESTON MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-14",
        "last_updated": "2018-05-17",
        "status": "A",
        "authorized_official_last_name": "PETTS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "DIRECTOR OF AMBULATORY SERVICES, AO",
        "authorized_official_telephone_number": "304-388-7400",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WV",
            "license": "MP0552417",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2149740",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3910007155",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 May 17, 2018; 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.