NPIMap

Organization Active NPI

Monongahela Valley Association of Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Fairmont, WV
National Provider Identifier
1578041182
Registry record updated Mar 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
1034-6686 Issued in WV
Legal business name
MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTER, INC.
Doing business as
MVA East Fairmont Middle School Wellness Center
Practice address
221 Mason St
Fairmont, WV 26554-4188
Phone
(304) 367-2123
Fax
(304) 367-8766
NPI assigned
Aug 6, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2022

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

Authorized official

Name
Nancy Louise Vandergrift
Title
President
Phone
(304) 367-8740

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 1034-6686 WV Primary

Addresses

Primary practice location

221 Mason St
Fairmont, WV 26554-4188

Mailing address

PO Box 1112
Fairmont, WV 26555-1112
Phone (304) 367-2123

Other names 1

  • MVA East Fairmont Middle School Wellness Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080220000201 WV Part B Supplier - Public Health/Welfare Agency 6800991977 Receives reassigned benefits from 20 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Shinnston, WV; Mannington, WV; Fairmont, WV; Farmington, WV

Federally qualified health center certification: CCN 511155

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MVA EAST FAIRMONT MIDDLE SCHOOL WELLNESS CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 4, 2018
Last certification
Sep 4, 2018
Ownership / control type
For profit – corporation
Facility address
221 Mason Street
Fairmont, WV 26554

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1533513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647907200000",
    "number": "1578041182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1112",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265551112",
            "telephone_number": "304-367-2123",
            "fax_number": "304-687-8766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 MASON ST",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265544188",
            "telephone_number": "304-367-2123",
            "fax_number": "304-367-8766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-06",
        "last_updated": "2022-03-22",
        "certification_date": "2022-03-22",
        "status": "A",
        "authorized_official_last_name": "VANDERGRIFT",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-367-8740"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WV",
            "license": "1034-6686",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MVA East Fairmont Middle School Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MVA East Fairmont Middle School Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairmont, WV

Sources for this page

Verify at the official NPI Registry.