NPIMap

Organization Active NPI

Selby General Hospital

Doing business as Dept of Primary Care Waterford

  • Rural Health Clinic/Center
  • Waterford, OH
National Provider Identifier
1750180162
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
Doing business as
Dept of Primary Care Waterford
Practice address
151 Anderson LN
Waterford, OH 45786-5312
Phone
(740) 984-2332
Fax
(740) 984-4435
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

151 Anderson LN
Waterford, OH 45786-5312

Mailing address

401 Matthew St
Marietta, OH 45750-1635

Other names 1

  • Dept of Primary Care Waterford Doing business as

Medicare participation

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

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750180162. Details of each certification follow.

Rural health clinic certification: CCN 363460

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
DEPT OF PRIMARY CARE WATERFORD
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 15, 2025
Last certification
Aug 15, 2025
Ownership / control type
2B
Facility address
151 Anderson LN
Waterford, OH 45786
Related CCNs
361319

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
36D0351164Selby General Hospital151 Anderson Lane, Waterford, OH 45786Certificate of waiverApr 10, 2028

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.

Locations

151 Anderson Ln
Waterford, OH 45786
Phone (740) 984-2332

Ownership & related parties

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 7

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": "1750180162",
    "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": "151 ANDERSON LN",
            "city": "WATERFORD",
            "state": "OH",
            "postal_code": "457865312",
            "telephone_number": "740-984-2332",
            "fax_number": "740-984-4435"
        }
    ],
    "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 Waterford",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waterford, OH

Sources for this page

Verify at the official NPI Registry.