NPIMap

Organization Active NPI

Williamson Health & Wellness Center Inc

  • Federally Qualified Health Center (FQHC)
  • Williamson, WV
National Provider Identifier
1740836873
Registry record updated Oct 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WILLIAMSON HEALTH & WELLNESS CENTER INC
Practice address
5 Parkway Dr
Williamson, WV 25661-3428
Phone
(304) 236-5902
Fax
(855) 487-4047
NPI assigned
Aug 14, 2019
Organization subpart
Yes
Parent organization
WILLIAMSON HEALTH & WELLNESS CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 13, 2022

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

Authorized official

Name
Christopher Donovan BeckettNPI 1174575898
Title
Ceo
Phone
(304) 236-5902

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

5 Parkway Dr
Williamson, WV 25661-3428

Mailing address

PO Box 2080
Williamson, WV 25661-2080
Phone (304) 236-5902

Other names 1

  • Williamson Health & Wellness Center Williamson PK8 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230721002426 WV Part A Provider - Federally Qualified Health Center (FQHC) 5395972996 Practice locations: Williamson, WV

Federally qualified health center certification: CCN 581040

Legal name
WILLIAMSON HEALTH & WELLNESS CENTER INC
Doing business as
WILLIAMSON HEALTH & WELLNESS CENTER-WILLIAMSON PK-8
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 18, 2024
Last certification
Mar 18, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 1, 2014 in WV
Enrollment address
5 Parkway Dr
Williamson, WV 25661-3428

Other NPIs with the same Medicare PAC ID 14

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

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Williamson Health Wellness Center Inc18 organizations share this tax ID, including this one
Part of
Williamson Health Wellness Center Inc

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Christopher Donovan Beckett Individual 5% Or Greater Direct Ownership Interest May 18, 2023 100%
Corporate OfficerCeo May 18, 2023 100%
Operational/Managerial Control May 18, 2023

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Williamson Health & Wellness Center- Behavioral Medicine ClinicWilliamson, WV, CCN 510094 Hospital 5% Or Greater Direct Ownership Interest (100%) May 31, 2020
Williamson Health & Wellness Center IncWilliamson, WV, CCN 511032 Federally qualified health center Operational/Managerial Control Sep 3, 2013
Williamson Health & Wellness Center-Matewan PK-8Matewan, WV, CCN 581078 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2024

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1565740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665619200000",
    "number": "1740836873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2080",
            "city": "WILLIAMSON",
            "state": "WV",
            "postal_code": "256612080",
            "telephone_number": "304-236-5902",
            "fax_number": "855-487-4047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 PARKWAY DR",
            "city": "WILLIAMSON",
            "state": "WV",
            "postal_code": "256613428",
            "telephone_number": "304-236-5902",
            "fax_number": "855-487-4047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAMSON HEALTH & WELLNESS CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILLIAMSON HEALTH & WELLNESS CENTER",
        "enumeration_date": "2019-08-14",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A",
        "authorized_official_last_name": "BECKETT",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "DONOVAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-236-5902"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Williamson Health & Wellness Center Williamson PK8",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Williamson Health & Wellness Center Williamson PK8",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Williamson, WV

Sources for this page

Verify at the official NPI Registry.