NPIMap

Organization Active NPI

Boone Primary Care Clinic

  • Internal Medicine Physician
  • Madison, WV
National Provider Identifier
1578634697
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
19477 Issued in WV
Legal business name
BOONE PRIMARY CARE CLINIC
Practice address
340 State St
Madison, WV 25130-1365
Phone
(304) 307-6618
Fax
(304) 307-6619
NPI assigned
Nov 11, 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
Wenqing Long, MD
Title
Owner
Phone
(304) 307-6618

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 19477 WV Primary

Addresses

Primary practice location

340 State St
Madison, WV 25130-1365

Mailing address

340 State St
Madison, WV 25130-1365
Phone (304) 307-6618

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1163203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1578634697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 STATE ST",
            "city": "MADISON",
            "state": "WV",
            "postal_code": "251301365",
            "telephone_number": "304-307-6618",
            "fax_number": "304-307-6619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 STATE ST",
            "city": "MADISON",
            "state": "WV",
            "postal_code": "251301365",
            "telephone_number": "304-307-6618",
            "fax_number": "304-307-6619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOONE PRIMARY CARE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "WENQING",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-307-6618",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "WV",
            "license": "19477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, 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.