NPIMap

Organization Active NPI

Williamson Health & Wellness Center Inc

Doing business as Williamson Health & Wellness Center-Dental Clinic

  • Federally Qualified Health Center (FQHC)
  • Williamson, WV
National Provider Identifier
1619536604
Registry record updated Aug 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WILLIAMSON HEALTH & WELLNESS CENTER INC
Doing business as
Williamson Health & Wellness Center-Dental Clinic
Practice address
180 E 2ND Ave
Williamson, WV 25661-3602
Phone
(304) 236-5902
Fax
(855) 487-4047
NPI assigned
Jun 12, 2019
Last updated
Aug 25, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
WILLIAMSON HEALTH & WELLNESS CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 25, 2022

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

Authorized official

Name
Christopher Donovan BeckettNPI 1174575898
Title
Ceo
Phone
(304) 235-1844

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

180 E 2ND Ave
Williamson, WV 25661-3602

Mailing address

PO Box 2080
Williamson, WV 25661-2080
Phone (304) 236-5902

Other names 1

  • Williamson Health & Wellness Center-Dental Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140521000620 WV Part B Supplier - Clinic/Group Practice 5395972996 Receives reassigned benefits from 31 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Williamson, WV; Lavalette, WV; Matewan, WV; Delbarton, WV
O20230119001739 WV Part A Provider - Federally Qualified Health Center (FQHC) 5395972996 Practice locations: Williamson, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619536604. Details of each certification follow.

Federally qualified health center certification: CCN 581013

Legal name
WILLIAMSON HEALTH & WELLNESS CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 19, 2023
Last certification
Jan 19, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 2014 in WV
Enrollment address
180 E 2ND Ave
Williamson, WV 25661-3602

Other NPIs with the same Medicare PAC ID 14

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 14

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
Williamson Health and Well18 organizations share this tax ID, including this one
Part of
Williamson Health and Well

Other organizations with this tax ID 17

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

View all 17

Locations

180 E 2nd Ave
Williamson, WV 25661

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Christopher Donovan Beckett Individual 5% Or Greater Direct Ownership InterestManagerial Nov 1, 2022 100%
Corporate OfficerCeo Nov 1, 2022 100%
Operational/Managerial Control Nov 1, 2022

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Williamson Health & Wellness Center- Behavioral Medicine ClinicWilliamson, WV, CCN 510094 Hospital 5% Or Greater Direct Ownership Interest (100%) May 31, 2020
Williamson Health & Wellness Center IncWilliamson, WV, CCN 511032 Federally qualified health center Operational/Managerial Control Sep 3, 2013
Williamson Health & Wellness Center-Matewan PK-8Matewan, WV, CCN 581078 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2024

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1560297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661385600000",
    "number": "1619536604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2080",
            "city": "WILLIAMSON",
            "state": "WV",
            "postal_code": "256612080",
            "telephone_number": "304-236-5902",
            "fax_number": "855-487-4047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 E 2ND AVE",
            "city": "WILLIAMSON",
            "state": "WV",
            "postal_code": "256613602",
            "telephone_number": "304-236-5902",
            "fax_number": "855-487-4047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAMSON HEALTH & WELLNESS CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILLIAMSON HEALTH & WELLNESS CENTER INC",
        "enumeration_date": "2019-06-12",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A",
        "authorized_official_last_name": "BECKETT",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "DONOVAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-235-1844"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Williamson Health & Wellness Center-Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Williamson, WV

Sources for this page

Verify at the official NPI Registry.