NPIMap

Organization Active NPI

Camden on Gauley Medical Center Inc

Doing business as Camden Family Dentistry

  • Federally Qualified Health Center (FQHC)
  • Craigsville, WV
National Provider Identifier
1639611452
Registry record updated May 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CAMDEN ON GAULEY MEDICAL CENTER INC
Doing business as
Camden Family Dentistry
Practice address
16414 Webster Rd
Craigsville, WV 26205-8512
Phone
(304) 742-3004
Fax
(304) 226-3274
NPI assigned
Nov 10, 2016
Last updated
May 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2024

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

Authorized official

Name
Margaret Hickey
Title
Ceo
Phone
(304) 226-5725

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

16414 Webster Rd
Craigsville, WV 26205-8512

Mailing address

10003 Webster Rd
Camden on Gauley, WV 26208-7713
Phone (304) 226-5725

Other identifiers 1

IdentifierTypeStateIssuer
1639611452-001MedicaidWV

Other names 1

  • Camden Family Dentistry Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170217000202 WV Part A Provider - Federally Qualified Health Center (FQHC) 6002867850 Practice locations: Craigsville, WV
O20200925000111 WV Part B Supplier - Clinic/Group Practice 6002867850 Receives reassigned benefits from 2 practitioners
Practice locations: Craigsville, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639611452. Details of each certification follow.

Federally qualified health center certification: CCN 511121

Legal name
CAMDEN ON GAULEY MEDICAL CENTER INC
Doing business as
CAMDEN FAMILY DENTISTRY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 6, 2017
Last certification
Jan 6, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 1979 in WV
Enrollment address
16414 Webster Rd
Craigsville, WV 26205-8512

Other NPIs with the same Medicare PAC ID 24

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

View all 24

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Roy Moose Individual Corporate DirectorBoard Member Jan 1, 2010
Elizabeth Snyder Individual Corporate DirectorBoard Member Jan 1, 1997
Barbara Butler Individual Corporate DirectorBoard Member Nov 28, 2019
Brandon Moll Individual Corporate DirectorBoard Member Aug 12, 2022
Sharon Hanna Individual Corporate DirectorBoard Member Jan 1, 1981
Margaret Hickey Individual Corporate OfficerCeo Mar 1, 2011
W-2 Managing EmployeeCeo Mar 1, 2011
Operational/Managerial ControlCeo Mar 1, 2011
James Gamble Individual Corporate DirectorBoard Member Jan 1, 1989
Melissa Rogers Individual Corporate OfficerCoo Mar 4, 2014
Tiffany Montgomery Individual Corporate DirectorBoard Member Mar 22, 2021
Jane Sherwood Individual Corporate DirectorBoard Member Jan 1, 1997

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Camden Family HealthCraigsville, WV, CCN 511091 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Nov 1, 1979
Camden on Gauley Medical Center IncSummersville, WV, CCN 511145 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Nov 1, 1979

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": "1478736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715126400000",
    "number": "1639611452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10003 WEBSTER RD",
            "city": "CAMDEN ON GAULEY",
            "state": "WV",
            "postal_code": "262087713",
            "telephone_number": "304-226-5725",
            "fax_number": "304-226-3274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16414 WEBSTER RD",
            "city": "CRAIGSVILLE",
            "state": "WV",
            "postal_code": "262058512",
            "telephone_number": "304-742-3004",
            "fax_number": "304-226-3274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMDEN ON GAULEY MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-10",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A",
        "authorized_official_last_name": "HICKEY",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-226-5725"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639611452-001",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Camden Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Camden Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Craigsville, WV

Sources for this page

Verify at the official NPI Registry.