NPIMap

Organization Active NPI

Preston Taylor Community Health Centers, Incorporated

Doing business as Community Eye Care

  • Federally Qualified Health Center (FQHC)
  • Grafton, WV
National Provider Identifier
1871365304
Registry record updated Aug 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PRESTON TAYLOR COMMUNITY HEALTH CENTERS, INCORPORATED
Doing business as
Community Eye Care
Practice address
216 Lincoln St
Grafton, WV 26354-1442
Phone
(304) 265-1851
Fax
(304) 265-0028
NPI assigned
Oct 27, 2023
Last updated
Aug 7, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
PRESTON TAYLOR COMMUNITY HEALTH CENTERS, INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 7, 2024

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

Authorized official

Name
Elizabeth J Griffith
Title
Ceo
Phone
(304) 265-0312

Specialties & licenses 1

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

Addresses

Primary practice location

216 Lincoln St
Grafton, WV 26354-1442

Mailing address

25 W Bluemont St
Grafton, WV 26354-1242
Phone (304) 265-0312

Other identifiers 3

IdentifierTypeStateIssuer
581043OtherWVMEDICARE
P793OtherWVMEDICARE
1871365304MedicaidWV

Other names 1

  • Community Eye Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240403001176 WV Part B Supplier - Clinic/Group Practice 3072406438 Receives reassigned benefits from 1 practitioner
Practice locations: Grafton, WV
O20240425003440 WV Part A Provider - Federally Qualified Health Center (FQHC) 3072406438 Practice locations: Grafton, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871365304. Details of each certification follow.

Federally qualified health center certification: CCN 581043

Legal name
PRESTON TAYLOR COMMUNITY HEALTH CENTERS, INCORPORATED
Doing business as
COMMUNITY EYE CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 9, 2024
Last certification
Apr 9, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 16, 1986 in WV
Enrollment address
216 Lincoln St
Grafton, WV 26354-1442

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Community Eye Care15 organizations share this tax ID, including this one
Part of
Community Eye Care

Other organizations with this tax ID 13

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

View all 13

Locations

216 Lincoln St
Grafton, WV 26354
Phone (304) 265-1851

1321 N Mountaineer Hwy
Newburg, WV 26410
Phone (304) 892-2812

2060 N Mountaineer Hwy
Newburg, WV 26410
Phone (304) 892-2812

72 Cortland Acres Ln
Thomas, WV 26292
Phone (301) 334-8282

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Vonda Reneman Individual Corporate DirectorBoard Member Jan 1, 2019
Karen Temple Individual Corporate DirectorBoard Member Apr 27, 2023
Mark Teets Individual Corporate DirectorBoard Member Oct 1, 2022
Victoria Hoffman Individual Corporate DirectorBoard Member Apr 27, 2023
Preston Taylor Community Health Centers, Incorporated Organization, Grafton, WV Corporation, Non-profit 5% Or Greater Direct Ownership Interest Mar 1, 2024 100%
Operational/Managerial Control Mar 1, 2024 100%
Elizabeth June Griffith Individual Corporate OfficerCeo Jan 16, 2022
W-2 Managing EmployeeCeo Jan 16, 2022
Operational/Managerial ControlCeo Mar 1, 2024 100%
Doug Lyons Individual Corporate DirectorBoard Member Sep 21, 2009
Patrick a Nichols Individual Corporate DirectorBoard Member Sep 27, 2001
Tony Veltri Individual Corporate DirectorBoard Member Jun 1, 1986
Hunter B Mullens Individual Corporate DirectorBoard Member Jun 25, 1997

Owners & managing parties with NPI records 7

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

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1698364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722988800000",
    "number": "1871365304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 W BLUEMONT ST",
            "city": "GRAFTON",
            "state": "WV",
            "postal_code": "263541242",
            "telephone_number": "304-265-0312",
            "fax_number": "304-265-0314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 LINCOLN ST",
            "city": "GRAFTON",
            "state": "WV",
            "postal_code": "263541442",
            "telephone_number": "304-265-1851",
            "fax_number": "304-265-0028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTON TAYLOR COMMUNITY HEALTH CENTERS, INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRESTON TAYLOR COMMUNITY HEALTH CENTERS, INCORPORATED",
        "enumeration_date": "2023-10-27",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A",
        "authorized_official_last_name": "GRIFFITH",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-265-0312"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "581043",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "P793",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1871365304",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Eye Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grafton, WV

Sources for this page

Verify at the official NPI Registry.