Southwest Virginia Community Health Systems Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Bristol, VA
NPI 1558041244 · NPPES record last updated Jul 19, 2023
Key facts
- NPI
- 1558041244
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- SOUTHWEST VIRGINIA COMMUNITY HEALTH SYSTEMS INC.
- Practice address
- 21264 Battle Hill Dr
Bristol, VA 24202-4340 - Phone
- (276) 642-5300
- NPI assigned
- Jul 19, 2023
- Organization subpart
- No
Authorized official
- Name
- Joseph Bryan Haynes
- Title
- Ceo
- Phone
- (276) 496-4492
Owners & managing parties with NPI records 2
-
Kristin Bresowar, M.D.
-
Norah Ann Nutter, WHNP
Owned or controlled facilities with NPI records 2
Other NPIs on the same Medicare enrollment 15
Other NPIs with the same Medicare PAC ID 14
Corporate family (same tax ID) 14
Practitioners 29
-
Morgan Johnson Trogdon, LCSW
-
Richard Allen Bare, LCSW, LCAS
-
Gayle Catherine Bates, M.D.
-
Brandon Parker Blevins, O.D.
-
Kristin Bresowar, M.D.
-
Edgar Camargo, M.D.
-
Chelsey N Cardwell, FNP
-
Janet Brooke Cuddy, FNP
-
Tammy Jean Davidson, NURSE PRACTITIONER
-
Melissa Ann Doane-Williams, L.C.S.W.
-
Cassandra Brooke Ellison, FNP-BC
-
Marie H Green, NP
-
Pamela Kay Meade, LCSW
-
James Thomas Miller, LCSW
-
Michael Murray Jr., FNP-BC
-
Vicente Ortiz, M.D.
-
Kimberly J Patrick, LCSW
-
Pamela McGhee Somervell, M.D.
-
Emily C Steffey-Stacy, PMHNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 49D2293790 | John Battle High School Clinic | Certificate of waiver | Nov 14, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VA
Federally qualified health center certification: CCN 491011
- Legal name
- SOUTHWEST VIRGINIA COMMUNITY HEALTH SYSTEMS INC
- Doing business as
- JOHN BATTLE HIGH SCHOOL
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Sep 13, 2023
- Last certification
- Sep 13, 2023
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Aug 7, 2001 in VA
- Enrollment address
- 21264 Battle Hill Dr
Bristol, VA 24202-4340
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Harold M. Leake |
Corporate Director |
Mar 1, 2012 | |
| Joseph Haynes |
Corporate Officer |
Sep 26, 2011 | |
| Operational/Managerial Control |
Sep 26, 2011 | ||
| Linda G Mullins |
Corporate Director |
Mar 18, 2019 | |
| Victoria Davidson |
Corporate Director |
Dec 14, 2006 | |
| Chad Brown |
W-2 Managing Employee |
Jan 1, 2018 | |
| Operational/Managerial Control |
Jan 1, 2018 | ||
| Jean Chapman |
Corporate Director |
Feb 15, 2018 | |
| George H Washington |
Corporate Director |
Mar 24, 2014 | |
| Kristin O Bresowar |
W-2 Managing Employee |
Aug 18, 2014 | |
| Norah Ann Nutter |
Corporate Director |
Jan 21, 2019 | |
| Patricia Fullen |
Corporate Director |
Sep 17, 2018 | |
| David Vance |
Corporate Director |
Feb 20, 2023 | |
| Richard Shane Harris |
Corporate Director |
Jul 17, 2023 | |
| Robert Ashley |
Corporate Director |
Nov 16, 2020 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Chilhowie High School |
Federally qualified health center | Operational/Managerial Control (100%) | Feb 29, 2024 |
| High Point Elementary School |
Federally qualified health center | Operational/Managerial Control (100%) | Oct 15, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031106000290 | VA | Part B Supplier - Clinic/Group Practice | 4880502707 |
Receives reassigned benefits from 33 practitioners 15 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Tazewell, VA; Saltville, VA; Meadowview, VA; Chilhowie, VA; Bristol, VA |
| O20230914000637 | VA | Part a Provider - Federally Qualified Health Center (FQHC) | 4880502707 | Practice locations: Bristol, VA |
National Provider Directory
- Tax ID family
- Southwest Virginia Community Health Systems Inc
Locations
319 5th Ave
Fl 1
Saltville, VA 24370
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
21264 Battle Hill Dr
Bristol, VA 24202-4340
Mailing address
PO Box 729
Saltville, VA 24370-0729
Phone (276) 496-4492
Other names
- John Battle High School
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- Spark Dental VA, PLLC
- Jennifer Hodgson Spitzer
- Alison Daniela Starkey
- Kelli Stevens
All providers in Bristol, VA · Federally Qualified Health Center (FQHC) in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 19, 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.