Activate Healthcare - Constellium

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

ACTIVATE HEALTHCARE - CONSTELLIUM

Practice address

859 Century Road
Ravenswood, WV 26164-0068

Phone

(304) 273-6261

Fax

(304) 273-6549

NPI assigned

Dec 13, 2016

Last updated

Dec 13, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Debra Geihsler

Title

Principal

Phone

(773) 697-3144

Specialties & licenses 1

Addresses

Tax ID family

Activate Healthcare - Constellium2 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.

• Activate Healthcare - Teamsters 175 & 505 Clinic

  • Primary Care Clinic/Center
  • South Charleston, WV
  • NPI 1578922878
  NPD tax ID

Locations

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

{
    "created_epoch": "1481587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481587200000",
    "number": "1700320579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "859 CENTURY ROAD",
            "city": "RAVENSWOOD",
            "state": "WV",
            "postal_code": "261640068",
            "telephone_number": "304-273-6261",
            "fax_number": "304-273-6549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "859 CENTURY ROAD",
            "city": "RAVENSWOOD",
            "state": "WV",
            "postal_code": "261640068",
            "telephone_number": "304-273-6261",
            "fax_number": "304-273-6549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVATE HEALTHCARE - CONSTELLIUM",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-13",
        "last_updated": "2016-12-13",
        "status": "A",
        "authorized_official_last_name": "GEIHSLER",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "PRINCIPAL",
        "authorized_official_telephone_number": "773-697-3144"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 200 South Ritchie Avenue Operations LLC (Ravenswood Village)
• Adrienne Virginia Acord, FNP
• Brandon Clark Adams
• Cassie Adkins
• Chloe Marie Allen
• Larry Arthur Baldwin Jr.
• Leslie Baldwin

• Primary Care Clinic/Center in Ravenswood, WV
• Providers in Ravenswood, WV by specialty
• Primary Care Clinic/Center in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2016; 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.