NPIMap

Organization Active NPI

Southern Psychiatric Services

  • Psychiatry Physician
  • Charleston, WV
National Provider Identifier
1578639878
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
SOUTHERN PSYCHIATRIC SERVICES
Practice address
414 Greenway Ave
Suite 200
Charleston, WV 25309-1426
Phone
(304) 414-9161
NPI assigned
Nov 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Randy L Warren, M.D.NPI 1972614774
Title
Owner
Phone
(304) 414-9161

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X WV Primary

Addresses

Primary practice location

414 Greenway Ave
Suite 200
Charleston, WV 25309-1426

Mailing address

414 Greenway Ave
Suite 200
Charleston, WV 25309-1426
Phone (304) 414-9161

Other identifiers 1

IdentifierTypeStateIssuer
3810003269MedicaidWV

National Provider Directory

National Provider Directory

Locations

414 Greenway Ave
Ste 200
South Charleston, WV 25309
Phone (304) 414-9161

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": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1578639878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 GREENWAY AVE",
            "address_2": "SUITE 200",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253091426",
            "telephone_number": "304-414-9161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 GREENWAY AVE",
            "address_2": "SUITE 200",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253091426",
            "telephone_number": "304-414-9161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PSYCHIATRIC SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "WARREN",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-414-9161",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810003269",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.