NPIMap

Organization Active NPI

Selby General Hospital

  • Rural Health Clinic/Center
  • Vincent, OH
National Provider Identifier
1740089150
Registry record updated Mar 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 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
Last updated
Mar 10, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
SELBY GENERAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 10, 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 Primary

Addresses

Primary practice location

40 White Oak Professional Ctr
Vincent, OH 45784-9117

Mailing address

401 Matthew St
Marietta, OH 45750-1635

Other names 1

  • Dept of Primary Care Barlow Former legal business name

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
O20250409001243 OH Part A Provider - Rural Health Clinic 9638087893 Practice locations: Vincent, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740089150. Details of each certification follow.

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
CorporationNon-profit
Enrollment address
40 White Oak Professional Ctr
Vincent, OH 45784-9117
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.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D0679149Selby General Hospital40 White Oak Professional Ctr, Vincent, OH 45784Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Selby General Hospital Inc7 organizations share this tax ID, including this one
Part of
Selby General Hospital Inc

Other organizations with this tax ID 6

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
James Barengo Individual Operational/Managerial ControlDirector Jan 1, 2014
Sheryl Holdren Individual Operational/Managerial ControlDirector Jan 1, 2017
Terry E Rataiczak Individual Operational/Managerial ControlDirector Jan 1, 2019
Carol a Schneeberger Individual Operational/Managerial ControlTreasurer Jan 1, 2020
Michael Iaderosa Individual Operational/Managerial ControlDirector Oct 1, 2002
Victoria McGee Individual W-2 Managing EmployeeProvider Enrollment Supervisor May 1, 2014
Joseph D Cooper Individual Operational/Managerial ControlDirector Jan 1, 2003
Rebekah Gilden Individual W-2 Managing EmployeeCompliance & Privacy Specialist Jun 1, 2011
Paul G Westbrock Individual Operational/Managerial ControlCompliance Officer Jun 1, 2000
Colleen Cook Individual Operational/Managerial ControlDirector Jan 1, 2010
Elizabeth a Helmick Individual Operational/Managerial ControlDirector Feb 1, 2021
Christopher Alexander Cockerham Individual Operational/Managerial ControlDirector Jan 1, 2020
Thomas Danford Individual Operational/Managerial ControlSecretary Jan 1, 2005
Matthew Pottmeyer Individual Operational/Managerial ControlDirector Jan 1, 2024
Hugh Sherman Individual Operational/Managerial ControlDirector Jan 1, 2024
Michael Archer Individual Operational/Managerial ControlPast Chairperson Jan 1, 2005
Gregg M Emerick Individual Operational/Managerial ControlVice Chairperson Jan 1, 2019
Stephen C Keiser Individual Operational/Managerial ControlChairperson 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 8

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": "1741564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741564800000",
    "number": "1740089150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 MATTHEW ST",
            "city": "MARIETTA",
            "state": "OH",
            "postal_code": "457501635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 WHITE OAK PROFESSIONAL CTR",
            "city": "VINCENT",
            "state": "OH",
            "postal_code": "457849117",
            "telephone_number": "740-678-2374",
            "fax_number": "740-678-8139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELBY GENERAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SELBY GENERAL HOSPITAL",
        "enumeration_date": "2025-03-10",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dept of Primary Care Barlow",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Vincent, OH

Sources for this page

Verify at the official NPI Registry.