NPIMap

Organization Active NPI

Coalfield Family Services, PLLC

Doing business as Coalfield Family Services

  • Clinical Social Worker
  • Fort Gay, WV
National Provider Identifier
1811353154
Registry record updated Sep 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
DP00944783 Issued in WV
Legal business name
COALFIELD FAMILY SERVICES, PLLC
Doing business as
Coalfield Family Services
Practice address
20824 Route 52
Fort Gay, WV 25514-7074
Phone
(304) 648-7100
Fax
(304) 648-7160
NPI assigned
Dec 31, 2015
Last updated
Sep 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2021

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

Authorized official

Name
Mr. Danny E Jude Jr., LICSWNPI 1316385792
Title
Owner
Phone
(304) 648-7100

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NU
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU
Professional Counselor 101YP2500X 1532 WV
Clinical Social Worker 1041C0700X DP00944783 WV Primary

Addresses

Primary practice location

20824 Route 52
Fort Gay, WV 25514-7074

Mailing address

20824 Route 52
Fort Gay, WV 25514-7074
Phone (304) 648-7100

Other names 1

  • Coalfield Family Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170531001074 WV Part B Supplier - Clinic/Group Practice 0143510909 Receives reassigned benefits from 2 practitioners
Practice locations: Fort Gay, WV

National Provider Directory

National Provider Directory
Tax ID family
Coalfield Family Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

10 Sammons Ln
Fort Gay, WV 25514
Phone (304) 648-7100

Practitioners & affiliated clinicians

Practitioners 10

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": "1451520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632182400000",
    "number": "1811353154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20824 ROUTE 52",
            "city": "FORT GAY",
            "state": "WV",
            "postal_code": "255147074",
            "telephone_number": "304-648-7100",
            "fax_number": "304-648-7160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20824 ROUTE 52",
            "city": "FORT GAY",
            "state": "WV",
            "postal_code": "255147074",
            "telephone_number": "304-648-7100",
            "fax_number": "304-648-7160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COALFIELD FAMILY SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-31",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A",
        "authorized_official_last_name": "JUDE",
        "authorized_official_first_name": "DANNY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-648-7100",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WV",
            "license": "1532",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WV",
            "license": "DP00944783",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coalfield Family Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Coalfield Family Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Gay, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 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.