NPIMap

Individual provider Active NPI

Charles Vance III, DO

  • Family Medicine Physician
  • Hamlin, WV
National Provider Identifier
1649250341
Registry record updated Jul 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
768 Issued in WV
Practice address
7400 Lynn Ave
Hamlin, WV 25523-1138
Phone
(304) 824-5806
Fax
(304) 824-5804
NPI assigned
Jan 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 768 WV Primary

Addresses

Primary practice location

7400 Lynn Ave
Hamlin, WV 25523-1138

Mailing address

7400 Lynn Ave
Hamlin, WV 25523-1138

Other identifiers 4

IdentifierTypeStateIssuer
000000229369OtherWVANTHEM
080188645OtherWVRR MEDICARE
001709560OtherWVMT. STATE
0049874000MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120307000693 WV Practitioner - Family Practice 6406015601 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
768WVMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lincoln County Primary Care Center, Inc. Current Accepting new patients
Lincoln County Primary Care Center, Inc Current Accepting new patients
Lincoln County Primary Care Center, Inc. Current Accepting new patients
Lincoln County Primary Care Center, Inc CurrentSince May 2, 2014 Accepting new patients
Lincoln County Primary Care Center, Inc. Current Accepting new patients
Lincoln County Primary Care Center, Inc Current Accepting new patients
Lincoln County Primary Care Center, Inc. Current Accepting new patients
Lincoln County Primary Care Center, Inc. Current Accepting new patients
Lincoln County Primary Care Center, Inc. CurrentSince May 2, 2014 Accepting new patients
National Emergency Services West Virginia Inc Past Accepting new patients
Lincoln County Primary Care Center, Inc Past Accepting new patients

Locations

5322 McClellan Hwy
Branchland, WV 25506
Phone (304) 824-5707

7400 Lynn Ave
Hamlin, WV 25523

1 Wildcat Way
Logan, WV 25601
Phone (304) 688-9949

122 Nick Savas Dr
Logan, WV 25601
Phone (304) 752-8081

1 Pioneer Path
Man, WV 25635
Phone (304) 583-7295

650 E McDonald Ave
Man, WV 25635
Phone (304) 583-8585

59 Vanatters Crk
Ranger, WV 25557
Phone (304) 778-3084

1563 Sand Plant Rd
South Charleston, WV 25309
Phone (304) 756-1500

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1500336000000",
    "number": "1649250341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 LYNN AVE",
            "city": "HAMLIN",
            "state": "WV",
            "postal_code": "255231138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7400 LYNN AVE",
            "city": "HAMLIN",
            "state": "WV",
            "postal_code": "255231138",
            "telephone_number": "304-824-5806",
            "fax_number": "304-824-5804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANCE",
        "first_name": "CHARLES",
        "name_suffix": "III",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-19",
        "last_updated": "2017-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "768",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000229369",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "080188645",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MT. STATE",
            "identifier": "001709560",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0049874000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hamlin, WV

Sources for this page

Verify at the official NPI Registry.