E. a. Hawse Health Center, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Moorefield, WV
NPI 1487428009 · NPPES record last updated Nov 14, 2023
Key facts
- NPI
- 1487428009
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- E. A. HAWSE HEALTH CENTER, INC.
- Practice address
- 112 Kuykendall LN
Moorefield, WV 26836-1167 - Phone
- (304) 897-5915
- NPI assigned
- Nov 14, 2023
- Organization subpart
- No
Authorized official
- Name
- Melissa Thompson
- Title
- Ceo
- Phone
- (304) 897-5915
Other NPIs with the same Medicare PAC ID 17
Corporate family (same tax ID) 23
Practitioners 20
-
Katelynn Stickley, PA-C
-
Heather Jane Barger, APRN, FNP-BC
-
Lisa Marie Basye, PAC
-
Arthur J Cerami Jr., PA-C
-
Cassandra B Ford, RPH
-
Tiffany Lee Garner, ARNP
-
Elizabeth Hott, NP-C
-
Jacquelyn Marie Kessel, MSN, APRN, FNP-C
-
Mark W Puffenberger, M.D.
-
Jessica Marie Riggleman, APRN
-
Carrie A. Rogers, LPC
-
Elaine Marie Smith, P.A.-C
-
Elizabeth Theresa Smith, M.D.
-
Eileen Therese Tehan, LCSW
-
Joseph O Yeater, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 51D2295419 | Ea Hawse Health Center, Inc Love Clinic | Provider-performed microscopy | Dec 11, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WV
Federally qualified health center certification: CCN 581048
- Legal name
- E. A. HAWSE HEALTH CENTER, INC.
- Doing business as
- E. A. HAWSE HEALTH CENTER, INC.-LOVE CLINIC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Aug 14, 2024
- Last certification
- Aug 14, 2024
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 112 Kuykendall LN
Moorefield, WV 26836-1167
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Celesta Miller |
Corporate Officer |
Feb 1, 2020 | |
| Brenda Leigh Thompson |
Operational/Managerial Control |
Dec 1, 2001 | |
| Joann Kuhn |
Corporate Director | Oct 1, 2019 | |
| Michael Funkhouser |
Corporate Director | Sep 1, 2022 | |
| Imogen Helsley |
Corporate Director | Feb 1, 2023 | |
| Ralph Fitzwater |
Corporate Officer |
Dec 1, 2019 | |
| John Treadway |
Corporate Director | Feb 1, 2023 | |
| Cheryl L Sherman |
Operational/Managerial Control |
Jan 1, 2019 | |
| Stacey Heavner |
Corporate Director | Dec 1, 2009 | |
| Kristopher Kerr |
Corporate Director | May 1, 2016 | |
| David Mayfield |
Corporate Officer |
Jun 1, 2020 | |
| Melissa Thompson |
Contracted Managing Employee |
Dec 1, 2019 | |
| Corporate Officer |
Jan 1, 2019 | ||
| Tracey Ratliff |
Corporate Director | Oct 1, 2009 | |
| Regina Whetzel |
Corporate Officer |
Nov 1, 2011 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240820002562 | WV | Part a Provider - Federally Qualified Health Center (FQHC) | 6204728041 | Practice locations: Moorefield, WV |
| O20241119003433 | WV | Part B Supplier - Clinic/Group Practice | 6204728041 | Practice locations: Moorefield, WV |
National Provider Directory
- Tax ID family
- E a Hawse Health Center Inc
Locations
111 S Grove St
Ste 1
Petersburg, WV 26847
Phone (304) 257-2451
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
112 Kuykendall LN
Moorefield, WV 26836-1167
Mailing address
PO Box 97
Baker, WV 26801-0097
Phone (304) 897-5915
Other names
- E. A. Hawse Health Center, Inc.-Love Clinic
Other providers in Moorefield, WV
- Sabrina L Doubroff
- DRS RW & Ja Love Memorial Clinic
- Adam Jacob Dunn
- E. a. Hawse Health Center, Inc.
- E. a. Hawse Health Center, Inc.
- E. a. Hawse Health Center, Inc.
- E. a. Hawse Health Center, Inc.
- E. a. Hawse Health Center, Inc.
- E. a. Hawse Health Center, Inc.
- Jane Ellen Everett
All providers in Moorefield, 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 Nov 14, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.