NPIMap

Organization Active NPI

E. a. Hawse Health Center, Inc.

Doing business as E. a. Hawse Health Center, Inc.-Wardensville

  • Federally Qualified Health Center (FQHC)
  • Wardensville, WV
National Provider Identifier
1669074175
Registry record updated Dec 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
E. A. HAWSE HEALTH CENTER, INC.
Doing business as
E. a. Hawse Health Center, Inc.-Wardensville
Practice address
325 E. Main Street
Wardensville, WV 26851
Phone
(304) 874-4012
NPI assigned
Nov 10, 2020
Last updated
Dec 29, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2020

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

Authorized official

Name
Meredith Michelle Heishman
Title
Credentialing
Phone
(304) 897-5915

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

325 E. Main Street
Wardensville, WV 26851

Mailing address

PO Box 97
Baker, WV 26801-0097
Phone (304) 897-5915

Other names 1

  • E. A. HAWSE HEALTH CENTER, INC.-WARDENSVILLE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201211002021 WV Part A Provider - Federally Qualified Health Center (FQHC) 6204728041 Practice locations: Wardensville, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669074175. Details of each certification follow.

Federally qualified health center certification: CCN 581802

Legal name
E. A. HAWSE HEALTH CENTER, INC.
Doing business as
E. A. HAWSE HEALTH CENTER, INC.-WARDENSVILLE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 11, 2020
Last certification
Dec 11, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 10, 1980 in WV
Enrollment address
325 Main Street
Wardensville, WV 26851

Other NPIs with the same Medicare PAC ID 17

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

View all 17

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
51D2209037E a Hawse Health Center, Inc Wardensville325 East Main Street, Wardensville, WV 26851Provider-performed microscopyJan 10, 2027

National Provider Directory

National Provider Directory
Tax ID family
Ea Hawse Health Center24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

Organizations that report the same tax identification number in the National Provider Directory.

View all 23

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Celesta Miller Individual Corporate OfficerSecretary Feb 1, 2020
Brenda Leigh Thompson Individual Operational/Managerial ControlAdministrative Assistant Dec 4, 2001
Joann Kuhn Individual Corporate Director Nov 1, 2019
Ralph Fitzwater Individual Corporate OfficerBoard President Dec 1, 2019
Cheryl L Sherman Individual Operational/Managerial ControlBilling Supervisor Oct 1, 2018
Stacey Heavner Individual Corporate Director Dec 1, 2009
Kristopher Kerr Individual Corporate Director Dec 1, 2016
David Mayfield Individual Corporate OfficerTreasurer Jun 1, 2020
James Pyles Individual Corporate Director Jun 1, 2020
Melissa Thompson Individual W-2 Managing EmployeeCeo Jan 1, 2019
Tracey Ratliff Individual Corporate Director Sep 1, 2018
Regina Whetzel Individual Corporate OfficerBoard Vice President Jun 1, 2020

NPI Registry JSON

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

{
    "created_epoch": "1604966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609200000000",
    "number": "1669074175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 97",
            "city": "BAKER",
            "state": "WV",
            "postal_code": "268010097",
            "telephone_number": "304-897-5915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 E. MAIN STREET",
            "city": "WARDENSVILLE",
            "state": "WV",
            "postal_code": "26851",
            "telephone_number": "304-874-4012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "E. A. HAWSE HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-10",
        "last_updated": "2020-12-29",
        "certification_date": "2020-12-21",
        "status": "A",
        "authorized_official_last_name": "HEISHMAN",
        "authorized_official_first_name": "MEREDITH",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "304-897-5915"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "E. A. HAWSE HEALTH CENTER, INC.-WARDENSVILLE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wardensville, WV

Sources for this page

Verify at the official NPI Registry.