NPIMap

Organization Active NPI

Monongahela Valley Association of Health Centers, Inc

Doing business as MVA Fairmont Clinic

  • Federally Qualified Health Center (FQHC)
  • Fairmont, WV
National Provider Identifier
1770697278
Registry record updated Jan 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTERS, INC
Doing business as
MVA Fairmont Clinic
Practice address
1322 Locust Ave
Fairmont, WV 26554-1436
Phone
(304) 366-0700
Fax
(304) 366-9529
NPI assigned
Aug 19, 2006
Last updated
Jan 30, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2026

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

Authorized official

Name
Manuel Raymond Alvarez
Title
Ceo
Phone
(304) 367-8740

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1322 Locust Ave
Fairmont, WV 26554-1436

Mailing address

1322 Locust Ave
PO Box 1112
Fairmont, WV 26554-1436
Phone (304) 366-0700

Other identifiers 1

IdentifierTypeStateIssuer
0035167000MedicaidWV

Other names 1

  • MVA Fairmont Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070418000226 WV Part A Provider - Federally Qualified Health Center (FQHC) 6800991977 Practice locations: Fairmont, WV
O20080220000201 WV Part B Supplier - Public Health/Welfare Agency 6800991977 Receives reassigned benefits from 20 practitioners
10 other NPIs on this enrollment
Practice locations: Shinnston, WV; Mannington, WV; Fairmont, WV; Farmington, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770697278. Details of each certification follow.

Federally qualified health center certification: CCN 511923

Legal name
MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTERS, INC
Doing business as
MVA FAIRMONT CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 15, 2007
Last certification
May 15, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 6, 1958 in WV
Enrollment address
1322 Locust Ave
Fairmont, WV 26554-1436

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory

Locations

1 North Marion Dr
Farmington, WV 26571
Phone (304) 986-2550

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
John Lee Individual Corporate DirectorBoard Member Jan 17, 2025
Michael S Schroering Individual Corporate DirectorBoard Member Sep 19, 2014
Walter Cosner Individual Corporate DirectorBoard Member Jan 17, 2025
Delbert Carpenter Individual Corporate DirectorBoard Member Jan 18, 2019
Phillip Koloff Individual Corporate DirectorBoard Member Jan 1, 1985
Nancy Deming Individual Corporate DirectorBoard Member Jan 17, 2025
Gary Jack Individual Corporate DirectorBoard Member Jan 1, 2016
Stephanie Stevens Individual W-2 Managing EmployeeCorporate Treasurer Jan 15, 2021
Raymond Alvarez Individual Corporate OfficerInterim Ceo Dec 6, 2024
W-2 Managing EmployeeAd;Interim Ceo Dec 6, 2024
Operational/Managerial ControlInterim Ceo Dec 6, 2024
Memori Dobbs Individual Corporate DirectorBoard Member Jan 17, 2025
Belinda Eagle Individual Corporate DirectorBoard Member Jan 17, 2020
Jonathan Frantz Individual Corporate DirectorBoard Member Jan 17, 2025
Orman Richard Bowyer Individual Corporate DirectorChairman Jan 1, 1968
Deborah Jane Hiltz Individual Corporate DirectorBoard Member Jan 17, 2025
Eric Pulice Individual Corporate DirectorVice Chair Jan 17, 2025
Athena Stima Individual W-2 Managing EmployeeSecretary Nov 18, 2016
Thomas Dragich Individual Corporate DirectorBoard Member Jan 1, 2007

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Monongahela Valley Association of Health Centers, IncMannington, WV, CCN 511115 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769731200000",
    "number": "1770697278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1322 LOCUST AVE",
            "address_2": "PO BOX 1112",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265541436",
            "telephone_number": "304-366-0700",
            "fax_number": "304-366-9529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1322 LOCUST AVE",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265541436",
            "telephone_number": "304-366-0700",
            "fax_number": "304-366-9529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTERS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-19",
        "last_updated": "2026-01-30",
        "certification_date": "2026-01-30",
        "status": "A",
        "authorized_official_last_name": "ALVAREZ",
        "authorized_official_first_name": "MANUEL",
        "authorized_official_middle_name": "RAYMOND",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-367-8740"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0035167000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MVA Fairmont Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MVA Fairmont Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairmont, WV

Sources for this page

Verify at the official NPI Registry.