NPIMap

Organization Active NPI

Mva X-Ray Fairmont Clinic

  • Radiology Clinic/Center
  • Fairmont, WV
National Provider Identifier
1831491042
Registry record updated Sep 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
License
1034-6686 Issued in WV
Legal business name
MVA X-RAY FAIRMONT CLINIC
Practice address
1322 Locust Ave
Fairmont, WV 26554-1436
Phone
(304) 367-8740
Fax
(304) 366-9529
NPI assigned
Nov 19, 2010
Last updated
Sep 23, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTERS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 23, 2011

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

Authorized official

Name
Nancy L Vandergrift, MBA
Title
President
Phone
(304) 367-8740

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X 1034-6686 WV 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) 367-8740

Other identifiers 1

IdentifierTypeStateIssuer
0121537000MedicaidWV

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080220000201 WV Part B Supplier - Public Health/Welfare Agency 6800991977 Receives reassigned benefits from 20 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Shinnston, WV; Mannington, WV; Fairmont, WV; Farmington, WV

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
Part of
Mva X-Ray Fairmont Clinic

NPI Registry JSON

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

{
    "created_epoch": "1290124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316736000000",
    "number": "1831491042",
    "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": "304-367-8740",
            "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": "304-367-8740",
            "fax_number": "304-366-9529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MVA X-RAY FAIRMONT CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTERS, INC.",
        "enumeration_date": "2010-11-19",
        "last_updated": "2011-09-23",
        "status": "A",
        "authorized_official_last_name": "VANDERGRIFT",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-367-8740",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "WV",
            "license": "1034-6686",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0121537000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairmont, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2011; 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.