NPIMap

Organization Active NPI

St. George Medical Clinic Inc.

  • Federally Qualified Health Center (FQHC)
  • Parsons, WV
National Provider Identifier
1497853600
Registry record updated Jan 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ST. GEORGE MEDICAL CLINIC INC.
Practice address
8591 Holly Meadows Rd
Parsons, WV 26287-8604
Phone
(304) 478-3339
Fax
(304) 478-3311
NPI assigned
Sep 20, 2006
Last updated
Jan 22, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2014

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

Authorized official

Name
Mr. Paul Wamsley Jr.
Title
Ceo
Phone
(304) 478-3339

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

8591 Holly Meadows Rd
Parsons, WV 26287-8604

Mailing address

8591 Holly Meadows Rd
Parsons, WV 26287-8604
Phone (304) 478-3339

Other identifiers 1

IdentifierTypeStateIssuer
0035139000MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040511000664 WV Part B Supplier - Clinic/Group Practice 7911996244 Receives reassigned benefits from 17 practitioners
Practice locations: Davis, WV; Parsons, WV; Hambleton, WV
O20101102000289 WV Part A Provider - Federally Qualified Health Center (FQHC) 7911996244 Practice locations: Parsons, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497853600. Details of each certification follow.

Federally qualified health center certification: CCN 511800

Legal name
ST GEORGE MEDICAL CLINIC INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Feb 1, 1979 in WV
Enrollment address
8591 Holly Meadows Rd
Parsons, WV 26287-8604

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
51D0236291St George Medical Clinic, Inc8591 Holly Meadows Road, Parsons, WV 26287Certificate of waiverMar 30, 2027

National Provider Directory

National Provider Directory

Locations

6368 Appalachian Hwy
Davis, WV 26260
Phone (681) 435-0011

138 Crestview Dr
Hambleton, WV 26269
Phone (304) 478-6000

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Susan V Metzner Individual Corporate Director Feb 28, 2018
Chatel Jones Individual Corporate OfficerQuality Director Aug 1, 2020
W-2 Managing EmployeeQuality Director Aug 1, 2020
Stephanie Williams Individual Corporate Director Oct 1, 2013
Barbara Kincaid Individual Corporate Director May 1, 2023
Timothy Knotts Individual Corporate Director Dec 1, 2021
Kevin White Individual Corporate Director Apr 26, 2019
Samuel Goughnour Individual Corporate Director Jun 1, 2023
Linda Plaugher Individual Corporate Director Oct 30, 2018
Solena L Roberts Individual Corporate OfficerChief Medical Officer Jan 2, 2020
W-2 Managing EmployeeMD; Jan 2, 2020
Paul Wamsley Individual Corporate OfficerExecutive Director/Ceo Oct 26, 2010
W-2 Managing EmployeeExecutive Director Oct 26, 2010 100%
Brenda Nestor Individual Corporate Director Oct 1, 2013
Danielle Lambruno Individual Corporate OfficerCompliance Officer Jan 1, 2020
W-2 Managing EmployeeCompliance Officer Jan 1, 2020
Robert Burns Individual Corporate Director Oct 26, 2010

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 30

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.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390348800000",
    "number": "1497853600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8591 HOLLY MEADOWS RD",
            "city": "PARSONS",
            "state": "WV",
            "postal_code": "262878604",
            "telephone_number": "304-478-3339",
            "fax_number": "304-478-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8591 HOLLY MEADOWS RD",
            "city": "PARSONS",
            "state": "WV",
            "postal_code": "262878604",
            "telephone_number": "304-478-3339",
            "fax_number": "304-478-3311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. GEORGE MEDICAL CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2014-01-22",
        "status": "A",
        "authorized_official_last_name": "WAMSLEY",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-478-3339",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0035139000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Parsons, WV

Sources for this page

Verify at the official NPI Registry.