NPIMap

Organization Active NPI

Southwest Virginia Community Health Systems Incorporated

  • Federally Qualified Health Center (FQHC)
  • Saltville, VA
National Provider Identifier
1811967169
Registry record updated Nov 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTHWEST VIRGINIA COMMUNITY HEALTH SYSTEMS INCORPORATED
Practice address
319 5TH Ave
Saltville, VA 24370-3418
Phone
(276) 496-4492
Fax
(276) 496-4839
NPI assigned
Jan 26, 2006
Last updated
Nov 17, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2021

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

Authorized official

Name
Joseph Bryan Haynes
Title
Executive Director
Phone
(276) 496-4492

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

319 5TH Ave
Saltville, VA 24370-3418

Mailing address

PO Box 729
Saltville, VA 24370-0729
Phone (276) 496-4492

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031106000290 VA Part B Supplier - Clinic/Group Practice 4880502707 Receives reassigned benefits from 33 practitioners
15 other NPIs on this enrollment
Practice locations: Tazewell, VA; Saltville, VA; Meadowview, VA; Chilhowie, VA; Bristol, VA
O20061116000561 VA Part A Provider - Federally Qualified Health Center (FQHC) 4880502707 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tazewell, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811967169. Details of each certification follow.

Federally qualified health center certification: CCN 491871

Legal name
SOUTHWEST VIRGINIA COMMUNITY HEALTH SYSTEMS INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 19, 2007
Last certification
Jan 19, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 7, 2001 in VA
Enrollment address
386 Ben Bolt Ave
Tazewell, VA 24651

Other NPIs with the same Medicare PAC ID 14

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

View all 14

Other NPIs on the same Medicare enrollment 15

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

View all 15

National Provider Directory

National Provider Directory

Locations

308 W Main St
Saltville, VA 24370
Phone (276) 496-4433

319 5th Ave
Fl 1
Saltville, VA 24370

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Harold M. Leake Individual Corporate DirectorBoard Member Mar 1, 2012
Joseph Haynes Individual Corporate DirectorExecutive Director Sep 26, 2011
Linda G Mullins Individual Corporate DirectorBoard Member Mar 18, 2019
Bethel Frye Individual Corporate DirectorBoard Member Mar 24, 2014
Victoria Davidson Individual Corporate DirectorBoard Member Dec 14, 2006
Chad Brown Individual W-2 Managing EmployeeChief Operations Officer Jan 1, 2018
Steven Hylton Individual Corporate DirectorBoard Member Feb 15, 2016
Jean Chapman Individual Corporate DirectorBoard Member Feb 19, 2018
George H Washington Individual Corporate DirectorBoard Member Mar 24, 2014
Kristin O Bresowar Individual W-2 Managing EmployeeMedical Director Aug 18, 2014
Rachel Vaughn Individual Corporate DirectorBoard Member Feb 15, 2016
Mark Ensminger Individual Corporate DirectorBoard Member Feb 15, 2017
Norah Ann Nutter Individual Corporate DirectorBoard Member Jan 21, 2019
Patricia Fullen Individual Corporate DirectorBoard Member Sep 17, 2018

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Chilhowie High SchoolChilhowie, VA, CCN 491023 Federally qualified health center Operational/Managerial Control (100%) Feb 29, 2024
High Point Elementary SchoolBristol, VA, CCN 491040 Federally qualified health center Operational/Managerial Control (100%) Oct 15, 2024

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 41

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 41

NPI Registry JSON

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637107200000",
    "number": "1811967169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 729",
            "city": "SALTVILLE",
            "state": "VA",
            "postal_code": "243700729",
            "telephone_number": "276-496-4492",
            "fax_number": "276-496-4839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 5TH AVE",
            "city": "SALTVILLE",
            "state": "VA",
            "postal_code": "243703418",
            "telephone_number": "276-496-4492",
            "fax_number": "276-496-4839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST VIRGINIA COMMUNITY HEALTH SYSTEMS INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-26",
        "last_updated": "2021-11-17",
        "certification_date": "2021-11-17",
        "status": "A",
        "authorized_official_last_name": "HAYNES",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "BRYAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "276-496-4492"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saltville, VA

Sources for this page

Verify at the official NPI Registry.