NPIMap

Organization Active NPI

Sissonville Health Center

  • Family Medicine Physician
  • Sissonville, WV
National Provider Identifier
1780087346
Registry record updated Sep 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SISSONVILLE HEALTH CENTER
Practice address
7133 Sissonville Dr
Sissonville, WV 25320-9738
Phone
(304) 734-2040
Fax
(304) 734-2047
NPI assigned
Sep 26, 2014
Last updated
Sep 26, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2014

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

Authorized official

Name
Jennifer Russell
Title
Administrative Assistant
Phone
(304) 734-2040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

7133 Sissonville Dr
Sissonville, WV 25320-9738

Mailing address

PO Box 70
Dawes, WV 25054-0070
Phone (304) 734-2040

National Provider Directory

National Provider Directory
Tax ID family
Cabin Creek Health Center Pharmacy13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

7133 Sissonville Dr
Sissonville, WV 25320
Phone (304) 984-1576

NPI Registry JSON

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

{
    "created_epoch": "1411689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411689600000",
    "number": "1780087346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70",
            "city": "DAWES",
            "state": "WV",
            "postal_code": "250540070",
            "telephone_number": "304-734-2040",
            "fax_number": "304-734-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7133 SISSONVILLE DR",
            "city": "SISSONVILLE",
            "state": "WV",
            "postal_code": "253209738",
            "telephone_number": "304-734-2040",
            "fax_number": "304-734-2047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SISSONVILLE HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-26",
        "last_updated": "2014-09-26",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "304-734-2040"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sissonville, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.