NPIMap

Organization Active NPI

Williamsburg Area Medical Assistance Corporation

Doing business as Olde Towne Medical Center

  • Rural Health Clinic/Center
  • Williamsburg, VA
National Provider Identifier
1639137078
Registry record updated Jan 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WILLIAMSBURG AREA MEDICAL ASSISTANCE CORPORATION
Doing business as
Olde Towne Medical Center
Practice address
5249 Olde Towne Rd
Williamsburg, VA 23188-8111
Phone
(757) 259-3258
Fax
(757) 220-1953
NPI assigned
May 3, 2006
Last updated
Jan 29, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2008

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

Authorized official

Name
Denise A Bowles
Title
Business Manager
Phone
(757) 259-3254

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

5249 Olde Towne Rd
Williamsburg, VA 23188-8111

Mailing address

5249 Olde Towne Rd
Williamsburg, VA 23188-8111
Phone (757) 259-3258

Other names 1

  • Olde Towne Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080515000013 VA Part A Provider - Rural Health Clinic 3577632645 Practice locations: Williamsburg, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639137078. Details of each certification follow.

Rural health clinic certification: CCN 493825

Legal name
WILLIAMSBURG AREA MEDICAL ASSISTANCE CORPORATION
Doing business as
OLDE TOWNE MEDICAL AND DENTAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 11, 1995
Last certification
Apr 3, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1993 in VA
Enrollment address
5249 Olde Towne Rd
Olde Towne Medical and Dental Center
Williamsburg, VA 23188-8111

National Provider Directory

National Provider Directory
Tax ID family
Old Towne Medical Dental Center2 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.

Locations

5249 Olde Towne Rd
Williamsburg, VA 23188
Phone (757) 259-3254

5249 Olde Towne Rd
Ste D
Williamsburg, VA 23188
Phone (757) 259-3258

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Lisa Tinker Individual W-2 Managing EmployeeAssistant Business Manager Apr 18, 2022 1%
Jacob Cooper Individual W-2 Managing EmployeeBusiness Manager Feb 16, 2023 20%
Gregory Biernacki Individual Corporate DirectorMedical Director May 1, 2021
Aaron L Thompson Individual Corporate OfficerExecutive Director/Ceo Aug 1, 2020

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201564800000",
    "number": "1639137078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5249 OLDE TOWNE RD",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231888111",
            "telephone_number": "757-259-3258",
            "fax_number": "757-220-1953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5249 OLDE TOWNE RD",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231888111",
            "telephone_number": "757-259-3258",
            "fax_number": "757-220-1953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAMSBURG AREA MEDICAL ASSISTANCE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-03",
        "last_updated": "2008-01-29",
        "status": "A",
        "authorized_official_last_name": "BOWLES",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "757-259-3254"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Olde Towne Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Williamsburg, VA

Sources for this page

Verify at the official NPI Registry.