NPIMap

Organization Active NPI

South Charleston Primary Care

  • Family Medicine Physician
  • South Charleston, WV
National Provider Identifier
1689758476
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
10611 Issued in WV
Legal business name
SOUTH CHARLESTON PRIMARY CARE
Practice address
312 6TH Ave
Suite 3
South Charleston, WV 25303-1242
Phone
(304) 744-4532
Fax
(304) 744-3219
NPI assigned
Oct 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Terri Jo Coleman
Title
Office Manager
Phone
(304) 744-4532

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 10611 WV Primary

Addresses

Primary practice location

312 6TH Ave
Suite 3
South Charleston, WV 25303-1242

Mailing address

312 6TH Ave
Suite 3
South Charleston, WV 25303-1242
Phone (304) 744-4532

Other identifiers 1

IdentifierTypeStateIssuer
0009405002MedicaidWV

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1689758476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 6TH AVE",
            "address_2": "SUITE 3",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253031242",
            "telephone_number": "304-744-4532",
            "fax_number": "304-744-3219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 6TH AVE",
            "address_2": "SUITE 3",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253031242",
            "telephone_number": "304-744-4532",
            "fax_number": "304-744-3219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CHARLESTON PRIMARY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COLEMAN",
        "authorized_official_first_name": "TERRI",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "304-744-4532"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "10611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0009405002",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.