NPIMap

Organization Active NPI

P.R.I.D.E. Inc.

  • Preferred Provider Organization
  • Logan, WV
National Provider Identifier
1669664231
Registry record updated Aug 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
Legal business name
P.R.I.D.E. INC.
Practice address
699 Stratton St
Logan, WV 25601-4020
Phone
(304) 752-6868
Fax
(304) 752-1047
NPI assigned
Aug 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2007

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

Authorized official

Name
Ms. Brenda York
Title
Billing Clerk
Phone
(304) 752-6868

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X Primary

Addresses

Primary practice location

699 Stratton St
Logan, WV 25601-4020

Mailing address

PO Box 1346
Logan, WV 25601-1346
Phone (304) 752-6868

Other identifiers 1

IdentifierTypeStateIssuer
3810009467MedicaidWV

National Provider Directory

National Provider Directory
Tax ID family
Pride Community Services Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

NPI Registry JSON

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

{
    "created_epoch": "1187222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187222400000",
    "number": "1669664231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1346",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256011346",
            "telephone_number": "304-752-6868",
            "fax_number": "304-752-1047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "699 STRATTON ST",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256014020",
            "telephone_number": "304-752-6868",
            "fax_number": "304-752-1047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "P.R.I.D.E. INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-16",
        "last_updated": "2007-08-16",
        "status": "A",
        "authorized_official_last_name": "YORK",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "BILLING CLERK",
        "authorized_official_telephone_number": "304-752-6868",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810009467",
            "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 Aug 16, 2007; 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.