NPIMap

Organization Active NPI

St Charles Health Council Inc

Doing business as William A Davis Clinic

  • Federally Qualified Health Center (FQHC)
  • Saint Paul, VA
National Provider Identifier
1710104260
Registry record updated Jul 29, 2010
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
William A Davis Clinic
Practice address
1389 Dante Road
St Paul, VA 24283
Phone
(276) 762-0770
Fax
(276) 762-0678
NPI assigned
Apr 19, 2007
Last updated
Jul 29, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2010

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

Authorized official

Name
Malcolm Perdue
Title
Ceo
Phone
(276) 546-5310

Specialties & licenses 1

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

Addresses

Primary practice location

1389 Dante Road
St Paul, VA 24283

Mailing address

Clinic Drive
Highway 63 North
St Paul, VA 24283
Phone (276) 762-0770

Other identifiers 1

IdentifierTypeStateIssuer
007602979MedicaidVA

Other names 1

  • William A Davis Clinic 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…
O20070612000414 VA Part A Provider - Federally Qualified Health Center (FQHC) 0244124584 Practice locations: Saint Paul, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710104260. Details of each certification follow.

Federally qualified health center certification: CCN 491815

Legal name
ST. CHARLES HEALTH COUNCIL INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1973 in VA
Enrollment address
1389 Dante Rd
Saint Paul, VA 24283-3658

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.

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.

Ownership & related parties

All disclosed owners & managing parties 18

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 Jul 29, 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
Kathy Turner Individual Corporate DirectorBoard Member Jun 1, 2021
Gary Bush Individual Corporate DirectorBoard Member Jun 1, 2021

Practitioners & affiliated clinicians

Practitioners 5

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": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280361600000",
    "number": "1710104260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CLINIC DRIVE",
            "address_2": "HIGHWAY 63 NORTH",
            "city": "ST PAUL",
            "state": "VA",
            "postal_code": "24283",
            "telephone_number": "276-762-0770",
            "fax_number": "276-762-0678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1389 DANTE ROAD",
            "city": "ST PAUL",
            "state": "VA",
            "postal_code": "24283",
            "telephone_number": "276-762-0770",
            "fax_number": "276-762-0678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST CHARLES HEALTH COUNCIL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2010-07-29",
        "status": "A",
        "authorized_official_last_name": "PERDUE",
        "authorized_official_first_name": "MALCOLM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "276-546-5310"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007602979",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "William A Davis Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Paul, VA

Sources for this page

Verify at the official NPI Registry.