NPIMap

Organization Active NPI

Benwood Medical Clinic Inc

  • Family Medicine Physician
  • Benwood, WV
National Provider Identifier
1497861819
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BENWOOD MEDICAL CLINIC INC
Practice address
4850 Eoff St
Benwood, WV 26031-1008
Phone
(304) 233-1656
Fax
(304) 233-1667
NPI assigned
Aug 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Lawrence Charles Kelly, DO
Title
President Owner
Phone
(304) 233-1656

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

4850 Eoff St
Benwood, WV 26031-1008

Mailing address

4850 Eoff St
Benwood, WV 26031-1008
Phone (304) 233-1656

National Provider Directory

National Provider Directory

Locations

4850 Eoff St
Benwood, WV 26031
Phone (304) 233-1656

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497861819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4850 EOFF ST",
            "city": "BENWOOD",
            "state": "WV",
            "postal_code": "260311008",
            "telephone_number": "304-233-1656",
            "fax_number": "304-233-1667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4850 EOFF ST",
            "city": "BENWOOD",
            "state": "WV",
            "postal_code": "260311008",
            "telephone_number": "304-233-1656",
            "fax_number": "304-233-1667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENWOOD MEDICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "304-233-1656",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Benwood, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.