Camden on Gauley Medical Center Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Craigsville, WV
NPI 1639611452 · NPPES record last updated May 8, 2024
Key facts
- NPI
- 1639611452
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- CAMDEN ON GAULEY MEDICAL CENTER INC
- Practice address
- 16414 Webster Rd
Craigsville, WV 26205-8512 - Phone
- (304) 742-3004
- Fax
- (304) 226-3274
- NPI assigned
- Nov 10, 2016
- Organization subpart
- No
Authorized official
- Name
- Margaret Hickey
- Title
- Ceo
- Phone
- (304) 226-5725
Owned or controlled facilities with NPI records 3
Other NPIs with the same Medicare PAC ID 24
Practitioners 28
-
Kristin Gail Bailes, FNP-C
-
Patricia Renee Boone, FNP
-
Arrettia J. Bush, D.O.
-
Elizabeth Ann Coffman, FNP-BC
-
Keith Richard De Young, M.D.
-
Jennifer Rose Durham, APN
-
Matthew Fratczak, D.O.
-
Mark J Hardway, M.D.
-
Alexandra L Horne, OD FAAO
-
Misty James, FNP
-
Cierra Karp, FNP-BC
-
Janet Louise Leasher, O.D.
-
Hannah Gabrielle Lemasters, FNP-C
-
Anna Marie Philpott, APRN
-
Heather N Sharp-Spinks, MSW, LICSW, CAC, CCS
-
Milissa K Short, FNP-BC
-
Sarah Dawn Skaggs, CNM
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WV
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
- Corporation · Non-profit
- Incorporated
- Nov 1, 1979 in WV
- Enrollment address
- 16414 Webster Rd
Craigsville, WV 26205-8512
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Roy Moose |
Corporate Director |
Jan 1, 2010 | |
| Elizabeth Snyder |
Corporate Director |
Jan 1, 1997 | |
| Barbara Butler |
Corporate Director |
Nov 28, 2019 | |
| Brandon Moll |
Corporate Director |
Aug 12, 2022 | |
| Sharon Hanna |
Corporate Director |
Jan 1, 1981 | |
| Margaret Hickey |
Corporate Officer |
Mar 1, 2011 | |
| W-2 Managing Employee |
Mar 1, 2011 | ||
| Operational/Managerial Control |
Mar 1, 2011 | ||
| James Gamble |
Corporate Director |
Jan 1, 1989 | |
| Melissa Rogers |
Corporate Officer |
Mar 4, 2014 | |
| Tiffany Montgomery |
Corporate Director |
Mar 22, 2021 | |
| Jane Sherwood |
Corporate Director |
Jan 1, 1997 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Camden Family Health |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Nov 1, 1979 |
| Camden on Gauley Medical Center Inc |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Nov 1, 1979 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639611452-001 | Medicaid | WV |
Other names
- Camden Family Dentistry
Other providers in Craigsville, WV
- Tiarra Nichole Brown
- Melissa Broyles
- Chasity Byrd
- Camden on Gauley Medical Center Inc
- Camden on Gauley Medical Center Inc
- Camden on Gauley Medical Center Inc
- Camden on Gauley Medical Center, Inc
- Amanda S Carpenter
- Denise Case
- Cassie Chapman
All providers in Craigsville, WV · Federally Qualified Health Center (FQHC) in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.