NPIMap

Organization Active NPI

St. Charles Health Council Inc

Doing business as Holston Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Damascus, VA
National Provider Identifier
1679695316
Registry record updated Jun 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ST. CHARLES HEALTH COUNCIL INC
Doing business as
Holston Family Health Center
Practice address
306 South Shady Avenue
Damascus, VA 24236
Phone
(276) 475-5116
Fax
(276) 475-5665
NPI assigned
Apr 4, 2007
Last updated
Jun 23, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2011

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

Authorized official

Name
Malcom Perdue
Title
Chief Executive Officer
Phone
(276) 475-5116

Specialties & licenses 1

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

Addresses

Primary practice location

306 South Shady Avenue
Damascus, VA 24236

Mailing address

306 South Shady Avenue
Damascus, VA 24236
Phone (276) 475-5116

Other identifiers 1

IdentifierTypeStateIssuer
007603002MedicaidVA

Other names 1

  • Holston Family Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040209001103 VA Part B Supplier - Clinic/Group Practice 0244124584 Receives reassigned benefits from 26 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Honaker, VA; Vansant, VA; St Paul, VA; St Charles, VA; Saint Charles, VA; Jonesville, VA; Hurley, VA; Haysi, VA…
O20070612000363 VA Part A Provider - Federally Qualified Health Center (FQHC) 0244124584 Practice locations: Damascus, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679695316. Details of each certification follow.

Federally qualified health center certification: CCN 491843

Legal name
ST. CHARLES HEALTH COUNCIL INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 1, 2000
Last certification
Aug 1, 2000
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1973 in VA
Enrollment address
306S Shady Ave
Damascus, VA 24236
Related CCNs
491812

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
49D0232241Holston Family Health Center306 South Shady Ave, Damascus, VA 24236Provider-performed microscopyMar 11, 2027

National Provider Directory

National Provider Directory
Tax ID family
St Charles Health Council Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

276 Fieldstone Dr
Jonesville, VA 24263
Phone (276) 546-3001

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Betty Rose Individual Corporate DirectorBoard Member Jun 1, 2021
Rufus C Hay Individual Corporate DirectorBoard Member Jun 6, 1994
Joyce Williams Individual Corporate DirectorBoard Member Jun 1, 2021
Malcolm L Perdue Individual Corporate OfficerPresident, Ceo Jul 1, 1998 100%
Violet J Martin Individual Corporate DirectorBoard Member Jun 16, 1996
Douglas McConnell Individual Corporate DirectorBoard Member Feb 23, 2010
Homer Wayne Fields Individual Corporate DirectorBoard Member Jun 1, 2021
Rebecca Johnson Individual Corporate DirectorBoard Member Jun 1, 2021
Mary K Edwards Individual Corporate DirectorBoard Member May 21, 1998
Saundra Jones Individual W-2 Managing EmployeeCoo Aug 7, 2015
Nancy Mann Individual Corporate DirectorBoard Member Jun 1, 2021
Janice Harber Individual Corporate DirectorBoard Member Nov 27, 2007
Sherry Lowe Individual Corporate DirectorBoard Member Jun 1, 2021
Delores Anne Pennington Individual Corporate DirectorBoard Member Jun 1, 2021
Gregory D Edwards Individual Corporate DirectorBoard Member Feb 7, 1995
Deborah Bostic Individual Corporate DirectorBoard Member Jun 1, 2021
James Oquinn Individual Corporate DirectorBoard Member Jun 1, 2021
Kathy Turner Individual Corporate DirectorBoard Member Jun 1, 2021
Gary Bush Individual Corporate DirectorBoard Member Jun 21, 2021

Practitioners & affiliated clinicians

Practitioners 3

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": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308787200000",
    "number": "1679695316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 SOUTH SHADY AVENUE",
            "city": "DAMASCUS",
            "state": "VA",
            "postal_code": "24236",
            "telephone_number": "276-475-5116",
            "fax_number": "276-475-5665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 SOUTH SHADY AVENUE",
            "city": "DAMASCUS",
            "state": "VA",
            "postal_code": "24236",
            "telephone_number": "276-475-5116",
            "fax_number": "276-475-5665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CHARLES HEALTH COUNCIL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2011-06-23",
        "status": "A",
        "authorized_official_last_name": "PERDUE",
        "authorized_official_first_name": "MALCOM",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "276-475-5116"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007603002",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Holston Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Damascus, VA

Sources for this page

Verify at the official NPI Registry.