NPIMap

Organization Active NPI

Logan-Mingo Area Mental Health, Inc

  • Federally Qualified Health Center (FQHC)
  • Chattaroy, WV
National Provider Identifier
1861023699
Registry record updated Jan 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LOGAN-MINGO AREA MENTAL HEALTH, INC
Practice address
2954 Buffalo Creek Road
Chattaroy, WV 25667
Phone
(304) 792-7130
NPI assigned
Jan 30, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2020

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

Authorized official

Name
Angela Lynn Robertson
Title
Benefits Coordinator
Phone
(304) 792-7130

Specialties & licenses 1

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

Addresses

Primary practice location

2954 Buffalo Creek Road
Chattaroy, WV 25667

Mailing address

PO Box 176
Logan, WV 25601-0176
Phone (304) 792-7130

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200416001974 WV Part A Provider - Federally Qualified Health Center (FQHC) 0840240362 Practice locations: Chattaroy, WV

Federally qualified health center certification: CCN 511184

Legal name
LOGAN-MINGO AREA MENTAL HEALTH INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 17, 2020
Last certification
Mar 17, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 15, 1970 in WV
Enrollment address
2954 Buffalo Creek Rd
Chattaroy, WV 25667

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Logan Mingo Area Mental Health Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Donna J Cooke Individual Corporate Officer Mar 25, 2013
Corporate Director Mar 25, 2013
W-2 Managing Employee Mar 25, 2013
Operational/Managerial Control Mar 25, 2013

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1580342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580342400000",
    "number": "1861023699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 176",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256010176",
            "telephone_number": "304-792-7130",
            "fax_number": "304-896-5184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2954 BUFFALO CREEK ROAD",
            "city": "CHATTAROY",
            "state": "WV",
            "postal_code": "25667",
            "telephone_number": "304-792-7130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOGAN-MINGO AREA MENTAL HEALTH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-30",
        "last_updated": "2020-01-30",
        "certification_date": "2020-01-30",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "BENEFITS COORDINATOR",
        "authorized_official_telephone_number": "304-792-7130"
    },
    "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 Chattaroy, WV

Sources for this page

Verify at the official NPI Registry.