Selby General Hospital
Organization Active NPI Rural Health Clinic/Center · Vincent, OH
NPI 1740089150 · NPPES record last updated Mar 10, 2025
Key facts
- NPI
- 1740089150
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- SELBY GENERAL HOSPITAL
- Practice address
- 40 White Oak Professional Ctr
Vincent, OH 45784-9117 - Phone
- (740) 678-2374
- Fax
- (740) 678-8139
- NPI assigned
- Mar 10, 2025
- Organization subpart
- Yes
- Parent organization (as reported)
- SELBY GENERAL HOSPITAL
Authorized official
- Name
- Paul G Westbrock
- Title
- VP Legal Affairs
- Phone
- (740) 374-1581
Parent organization (reported in NPPES) 1
Owners & managing parties with NPI records 2
Other NPIs on the same Medicare enrollment 9
Other NPIs with the same Medicare PAC ID 9
Corporate family (same tax ID) 6
Related certifications (CCN) 1
Practitioners 8
-
Michael Archer, DO
-
Jared Carney, DO
-
Lloyd Dennis, M.D.
-
Kayla Slattery, NP
-
Makarem Abulimon, M.D.
-
Roselyne Knopf, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 36D0679149 | Selby General Hospital | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OH
Rural health clinic certification: CCN 363459
- Legal name
- SELBY GENERAL HOSPITAL
- Doing business as
- DEPT OF PRIMARY CARE BARLOW
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Aug 15, 2025
- Last certification
- Aug 15, 2025
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 40 White Oak Professional Ctr
Vincent, OH 45784-9117 - Related CCNs
- 361319
All disclosed owners & managing parties 18
| Name | Role | Since | Share |
|---|---|---|---|
| James Barengo |
Operational/Managerial Control |
Jan 1, 2014 | |
| Sheryl Holdren |
Operational/Managerial Control |
Jan 1, 2017 | |
| Terry E Rataiczak |
Operational/Managerial Control |
Jan 1, 2019 | |
| Carol a Schneeberger |
Operational/Managerial Control |
Jan 1, 2020 | |
| Michael Iaderosa |
Operational/Managerial Control |
Oct 1, 2002 | |
| Victoria McGee |
W-2 Managing Employee |
May 1, 2014 | |
| Joseph D Cooper |
Operational/Managerial Control |
Jan 1, 2003 | |
| Rebekah Gilden |
W-2 Managing Employee |
Jun 1, 2011 | |
| Paul G Westbrock |
Operational/Managerial Control |
Jun 1, 2000 | |
| Colleen Cook |
Operational/Managerial Control |
Jan 1, 2010 | |
| Elizabeth a Helmick |
Operational/Managerial Control |
Feb 1, 2021 | |
| Christopher Alexander Cockerham |
Operational/Managerial Control |
Jan 1, 2020 | |
| Thomas Danford |
Operational/Managerial Control |
Jan 1, 2005 | |
| Matthew Pottmeyer |
Operational/Managerial Control |
Jan 1, 2024 | |
| Hugh Sherman |
Operational/Managerial Control |
Jan 1, 2024 | |
| Michael Archer |
Operational/Managerial Control |
Jan 1, 2005 | |
| Gregg M Emerick |
Operational/Managerial Control |
Jan 1, 2019 | |
| Stephen C Keiser |
Operational/Managerial Control |
Jan 1, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
| O20250409001243 | OH | Part a Provider - Rural Health Clinic | 9638087893 | Practice locations: Vincent, OH |
National Provider Directory
- Tax ID family
- Selby Family Care
- Part of
- Selby Family Care
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
40 White Oak Professional Ctr
Vincent, OH 45784-9117
Mailing address
401 Matthew St
Marietta, OH 45750-1635
Other names
- Dept of Primary Care Barlow
Other providers in Vincent, OH
- Amy L. Rice
- Hanna L Richard
- Megan Riley
- Trisha Lynn Rippeto
- Natosha Leann Roberson
- Mistie Short-Bartlett
- Whitney Sims
- Kayla Slattery
- Andrea Jade Stockman
- Beatrice Marie Taylor
All providers in Vincent, OH · Rural Health Clinic/Center in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 10, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.