NPIMap

Organization Active NPI

Cleveland Health Ventures LLC

Doing business as Shelby Family Practice

  • Family Medicine Physician
  • Shelby, NC
National Provider Identifier
1649345935
Registry record updated Jul 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CLEVELAND HEALTH VENTURES LLC
Doing business as
Shelby Family Practice
Practice address
1124 N Washington St
Shelby, NC 28150-3862
Phone
(980) 487-1148
Fax
(704) 487-7753
NPI assigned
Nov 21, 2006
Last updated
Jul 12, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
CLEVELAND HEALTH VENTURES LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 12, 2013

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

Authorized official

Name
Mr. Daniel L. Wiens
Title
Senior Vice President of Operations
Phone
(704) 355-0648

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1124 N Washington St
Shelby, NC 28150-3862

Mailing address

PO Box 601884
Charlotte, NC 28260-1884
Phone (980) 487-1148

Other identifiers 2

IdentifierTypeStateIssuer
5905818MedicaidNC
NPB304MedicaidSC

Other names 1

  • Shelby Family Practice Doing business as

National Provider Directory

National Provider Directory
Part of
Cleveland Health Ventures

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373587200000",
    "number": "1649345935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601884",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601884",
            "telephone_number": "980-487-1148",
            "fax_number": "704-487-7753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 N WASHINGTON ST",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281503862",
            "telephone_number": "980-487-1148",
            "fax_number": "704-487-7753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEVELAND HEALTH VENTURES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLEVELAND HEALTH VENTURES LLC",
        "enumeration_date": "2006-11-21",
        "last_updated": "2013-07-12",
        "status": "A",
        "authorized_official_last_name": "WIENS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT OF OPERATIONS",
        "authorized_official_telephone_number": "704-355-0648",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5905818",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NPB304",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shelby Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shelby, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.