NPIMap

Organization Active NPI

Selby General Hospital

Doing business as Department of Primary Care Logan

  • Rural Health Clinic/Center
  • Logan, OH
National Provider Identifier
1710840251
Registry record updated Dec 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SELBY GENERAL HOSPITAL
Doing business as
Department of Primary Care Logan
Practice address
751 State Route 664 N Unit a
Logan, OH 43138-9250
Phone
(740) 385-9646
Fax
(740) 689-4430
NPI assigned
Dec 3, 2025
Last updated
Dec 3, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
SELBY GENERAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 3, 2025

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

Authorized official

Name
Paul G Westbrock
Title
VP, Legal Affairs
Phone
(740) 374-1581

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

751 State Route 664 N Unit a
Logan, OH 43138-9250

Mailing address

416 Colegate Dr BLDG 3
Marietta, OH 45750-9549
Phone (740) 374-6090

Other names 1

  • Department of Primary Care Logan Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040108000165 OH Part B Supplier - Clinic/Group Practice 9638087893 Receives reassigned benefits from 109 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Athens, OH; Waterford, OH; Vincent, OH; Marietta, OH; Logan, OH; Caldwell, OH
O20251211002431 OH Part A Provider - Rural Health Clinic 9638087893 Practice locations: Logan, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710840251. Details of each certification follow.

Rural health clinic certification: CCN 363462

Legal name
SELBY GENERAL HOSPITAL
Doing business as
DEPARTMENT OF PRIMARY CARE LOGAN
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 25, 2026
Last certification
Mar 25, 2026
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
751 State Route 664 N
Unit a
Logan, OH 43138-9250
Related CCNs
361319

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

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Part of
Selby General Hospital Inc

Locations

751 State Route 664 N
Unit A
Logan, OH 43138
Phone (740) 385-9646

1338 Colegate Dr
Marietta, OH 45750
Phone (740) 373-6669

300 E 8th St
Marietta, OH 45750
Phone (740) 374-6726

802 Wayne St
Marietta, OH 45750
Phone (740) 373-6726

154 S Main St
Woodsfield, OH 43793
Phone (740) 472-1330

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
James Barengo Individual Corporate DirectorBoard of Directors Jan 1, 2014
Sheryl Holdren Individual Corporate Director Jan 1, 2017
Terry E Rataiczak Individual Corporate Director Jan 1, 2019
Carol a Schneeberger Individual Corporate DirectorTreasurer Jan 1, 2020
Michael Iaderosa Individual Corporate Director Oct 1, 2002
Victoria McGee Individual W-2 Managing EmployeeProvider Enrollment Supervisor May 1, 2014
Joseph D Cooper Individual Corporate Director Jan 1, 2003
Rebekah Gilden Individual W-2 Managing EmployeeCompliance & Privacy Specialist Jun 1, 2011
Paul G Westbrock Individual Corporate OfficerCompliance Officer Jun 1, 2000
Colleen Cook Individual Corporate Director Jan 1, 2010
Elizabeth a Helmick Individual Corporate Director Feb 1, 2021
Christopher Alexander Cockerham Individual Corporate Director Jan 1, 2020
Thomas Danford Individual Corporate DirectorSecretary Jan 1, 2005
Matthew Pottmeyer Individual Corporate Director Jan 1, 2024
Hugh Sherman Individual Corporate Director Jan 1, 2024
Michael Archer Individual Corporate DirectorPast Chairperson Jan 1, 2005
Gregg M Emerick Individual Corporate DirectorVice Chairperson Jan 1, 2019
Stephen C Keiser Individual Corporate DirectorChairperson Jan 1, 2019

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 186

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.

View all 186

NPI Registry JSON

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

{
    "created_epoch": "1764720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764720000000",
    "number": "1710840251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 COLEGATE DR BLDG 3",
            "city": "MARIETTA",
            "state": "OH",
            "postal_code": "457509549",
            "telephone_number": "740-374-6090",
            "fax_number": "740-374-3165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 STATE ROUTE 664 N UNIT A",
            "city": "LOGAN",
            "state": "OH",
            "postal_code": "431389250",
            "telephone_number": "740-385-9646",
            "fax_number": "740-689-4430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELBY GENERAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SELBY GENERAL HOSPITAL",
        "enumeration_date": "2025-12-03",
        "last_updated": "2025-12-03",
        "certification_date": "2025-12-03",
        "status": "A",
        "authorized_official_last_name": "WESTBROCK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "VP, LEGAL AFFAIRS",
        "authorized_official_telephone_number": "740-374-1581"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Department of Primary Care Logan",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Logan, OH

Sources for this page

Verify at the official NPI Registry.