Activate Healthcare - Teamsters 175 & 505 Clinic

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

ACTIVATE HEALTHCARE - TEAMSTERS 175 & 505 CLINIC

Practice address

428 Division St
Suite 2
South Charleston, WV 25309-1469

Phone

(304) 768-0321

Fax

(304) 768-0322

NPI assigned

Feb 15, 2016

Last updated

Feb 15, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Debra Geihsler

Title

Principal

Phone

(773) 697-3144

Specialties & licenses 1

Addresses

Tax ID family

Activate Healthcare - Constellium2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Activate Healthcare - Constellium

  • Primary Care Clinic/Center
  • Ravenswood, WV
  • NPI 1700320579
  NPD tax ID

Locations

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

{
    "created_epoch": "1455494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455494400000",
    "number": "1578922878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2010 N DAMEN AVE",
            "address_2": "SUITE F",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606473284",
            "telephone_number": "773-697-3144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "428 DIVISION ST",
            "address_2": "SUITE 2",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091469",
            "telephone_number": "304-768-0321",
            "fax_number": "304-768-0322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVATE HEALTHCARE - TEAMSTERS 175 & 505 CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-15",
        "last_updated": "2016-02-15",
        "status": "A",
        "authorized_official_last_name": "GEIHSLER",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "PRINCIPAL",
        "authorized_official_telephone_number": "773-697-3144"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Abbott
• Kellee E. Abner, M.D.
• David Abramowitz, M.D.
• Absolute Care Clinic of South Charleston
• Lisa Acord
• Stephanie Adams-Stinnett
• Betty Adams
• Beverly Adams, LPN
• Emmitt Adams
• Erica Juanitta Adams, PTA

• Primary Care Clinic/Center in South Charleston, WV
• Providers in South Charleston, WV by specialty
• Primary Care Clinic/Center in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2016; 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.