NPIMap

Organization Active NPI

Healthy Habits Wellness Ctr, Inc

  • General Practice Physician
  • Logan, WV
National Provider Identifier
1659323665
Registry record updated Jul 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
785374 Issued in WV
Legal business name
HEALTHY HABITS WELLNESS CTR, INC
Practice address
140 Stollings Ave
Logan, WV 25601-4011
Phone
(304) 752-4594
Fax
(304) 752-5629
NPI assigned
May 17, 2006
Last updated
Jul 8, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2010

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

Authorized official

Name
Jon M Miller, DONPI 1841245339
Title
President
Phone
(304) 752-4594

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 785374 WV Primary

Addresses

Primary practice location

140 Stollings Ave
Logan, WV 25601-4011

Mailing address

140 Stollings Ave Ste 3
Logan, WV 25601-4035
Phone (304) 752-4594

Other identifiers 1

IdentifierTypeStateIssuer
3810002671MedicaidWV

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051020001114 WV Part B Supplier - Clinic/Group Practice 3072539790 Receives reassigned benefits from 5 practitioners
Practice locations: Logan, WV

National Provider Directory

National Provider Directory
Tax ID family
Healthy Habits Wellness Ctr2 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

258 Hanging Rock Hwy
Ste 3
Logan, WV 25601
Phone (304) 752-4594

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 5

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": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278547200000",
    "number": "1659323665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 STOLLINGS AVE STE 3",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256014035",
            "telephone_number": "304-752-4594",
            "fax_number": "304-752-5629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 STOLLINGS AVE",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256014011",
            "telephone_number": "304-752-4594",
            "fax_number": "304-752-5629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHY HABITS WELLNESS CTR, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2010-07-08",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-752-4594",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "WV",
            "license": "785374",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810002671",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Logan, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.