NPIMap

Organization Active NPI

Cleveland Health Ventures LLC

Doing business as Shelby Family Practice

  • Family Medicine Physician
  • Shelby, NC
National Provider Identifier
1841526712
Registry record updated Jun 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CLEVELAND HEALTH VENTURES LLC
Doing business as
Shelby Family Practice
Practice address
708 McBrayer Homestead Rd
Shelby, NC 28152-9532
Phone
(704) 434-8123
Fax
(704) 434-9919
NPI assigned
Oct 27, 2009
Last updated
Jun 18, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
CLEVELAND HEALTH VENTURES LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 18, 2013

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

Authorized official

Name
Mr. Daniel L. Wiens
Title
Senior Vice President
Phone
(704) 355-0648

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

708 McBrayer Homestead Rd
Shelby, NC 28152-9532

Mailing address

PO Box 601884
Charlotte, NC 28260-1884
Phone (704) 434-8123

Other identifiers 2

IdentifierTypeStateIssuer
NPB305MedicaidSC
5906847MedicaidNC

Other names 1

  • Shelby Family Practice Doing business as

National Provider Directory

National Provider Directory
Part of
Cleveland Health Ventures

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1256601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371513600000",
    "number": "1841526712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601884",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601884",
            "telephone_number": "704-434-8123",
            "fax_number": "704-434-9919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 MCBRAYER HOMESTEAD RD",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281529532",
            "telephone_number": "704-434-8123",
            "fax_number": "704-434-9919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEVELAND HEALTH VENTURES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLEVELAND HEALTH VENTURES LLC",
        "enumeration_date": "2009-10-27",
        "last_updated": "2013-06-18",
        "status": "A",
        "authorized_official_last_name": "WIENS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "704-355-0648",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NPB305",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5906847",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shelby Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shelby, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2013; 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.