NPIMap

Organization Active NPI

Mingo County Family Wellness Center LLC

  • Primary Care Clinic/Center
  • Williamson, WV
National Provider Identifier
1801283882
Registry record updated Jun 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
MINGO COUNTY FAMILY WELLNESS CENTER LLC
Practice address
872 Route 65
Williamson, WV 25661-7497
Phone
(304) 475-3700
Fax
(304) 475-3780
NPI assigned
Apr 17, 2015
Last updated
Jun 30, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2021

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

Authorized official

Name
Mrs. Aimee Michelle Colegrove, NPNPI 1245666817
Title
President/Healthcare Provider
Phone
(304) 475-3700

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
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

872 Route 65
Williamson, WV 25661-7497

Mailing address

872 Route 65
Williamson, WV 25661-7497
Phone (304) 475-3700

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150527001397 WV Part B Supplier - Clinic/Group Practice 9133449549 Receives reassigned benefits from 3 practitioners
Practice locations: Williamson, WV

National Provider Directory

National Provider Directory

Locations

872 Route 65
Williamson, WV 25661
Phone (304) 475-3700

Practitioners & affiliated clinicians

Practitioners 4

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": "1429228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625011200000",
    "number": "1801283882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "872 ROUTE 65",
            "city": "WILLIAMSON",
            "state": "WV",
            "postal_code": "256617497",
            "telephone_number": "304-475-3700",
            "fax_number": "304-475-3780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "872 ROUTE 65",
            "city": "WILLIAMSON",
            "state": "WV",
            "postal_code": "256617497",
            "telephone_number": "304-475-3700",
            "fax_number": "304-475-3780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINGO COUNTY FAMILY WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-17",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A",
        "authorized_official_last_name": "COLEGROVE",
        "authorized_official_first_name": "AIMEE",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "PRESIDENT/HEALTHCARE PROVIDER",
        "authorized_official_telephone_number": "304-475-3700",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamson, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.