NPIMap

Organization Active NPI

Fairmont Medical Group, Inc.

Doing business as Shinnston Clinical Lab

  • Clinical Medical Laboratory
  • Shinnston, WV
National Provider Identifier
1588800866
Registry record updated Dec 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
FAIRMONT MEDICAL GROUP, INC.
Doing business as
Shinnston Clinical Lab
Practice address
1 Columbia Rd
Shinnston, WV 26431-1016
Phone
(304) 367-8710
Fax
(304) 366-8529
NPI assigned
Dec 17, 2008
Last updated
Dec 17, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
FAIRMONT MEDICAL GROUP, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 17, 2008

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

Authorized official

Name
Ms. Nancy L. Vandergrift
Title
President
Phone
(304) 367-8740

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X NU Primary

Addresses

Primary practice location

1 Columbia Rd
Shinnston, WV 26431-1016

Mailing address

PO Box 1112
Fairmont, WV 26555-1112
Phone (304) 367-8710

Other identifiers 1

IdentifierTypeStateIssuer
51D0236497OtherWVCLIA #

Other names 1

  • SHINNSTON CLINICAL LAB Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Fairmont Med Group Inc3 organizations share this tax ID, including this one
Part of
Fairmont Med Group Inc

Other organizations with this tax ID 2

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1229472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229472000000",
    "number": "1588800866",
    "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": "304-367-8710",
            "fax_number": "304-366-9529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 COLUMBIA RD",
            "city": "SHINNSTON",
            "state": "WV",
            "postal_code": "264311016",
            "telephone_number": "304-367-8710",
            "fax_number": "304-366-8529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRMONT MEDICAL GROUP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAIRMONT MEDICAL GROUP, INC.",
        "enumeration_date": "2008-12-17",
        "last_updated": "2008-12-17",
        "status": "A",
        "authorized_official_last_name": "VANDERGRIFT",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-367-8740",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA #",
            "identifier": "51D0236497",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHINNSTON CLINICAL LAB",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shinnston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2008; 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.