NPIMap

Organization Active NPI

Potomac Valley Hospital of W VA , Inc

  • Rural Health Clinic/Center
  • Fort Ashby, WV
National Provider Identifier
1902444987
Registry record updated Dec 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
POTOMAC VALLEY HOSPITAL OF W VA , INC
Practice address
10261 Frankfort Hwy
Fort Ashby, WV 26719-4533
Phone
(304) 597-3600
Fax
(304) 285-3963
NPI assigned
Dec 20, 2019
Last updated
Dec 20, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
POTOMAC VALLEY HOSPITAL OF W VA , INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 20, 2019

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

Authorized official

Name
Sue A Wells
Title
Senior Director of Clinic Operation
Phone
(304) 597-3525

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

10261 Frankfort Hwy
Fort Ashby, WV 26719-4533

Mailing address

1370 Johnson Ave Ste 102
Bridgeport, WV 26330-1492
Phone (681) 342-3453

Other names 1

  • Fort Ashby Medical Center of Potomac Valley Hospital Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200219002125 WV Part A Provider - Rural Health Clinic 8123917788 Practice locations: Fort Ashby, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902444987. Details of each certification follow.

Rural health clinic certification: CCN 513425

Legal name
POTOMAC VALLEY HOSPITAL OF W VA , INC
Doing business as
FORT ASHBY RURAL HEALTH CLINIC OF POTOMAC VALLEY HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 12, 2020
Last certification
Aug 12, 2020
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1958 in WV
Enrollment address
10261 Frankfort Hwy
Fort Ashby, WV 26719-4533
Related CCNs
511315

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
51D2151147Fort Ashby Rural Health Clinic of Potomac10261 Frankfort Hwy, Fort Ashby, WV 26719Certificate of waiverJul 12, 2028

National Provider Directory

National Provider Directory
Tax ID family
Potomac Valley Hospital28 organizations share this tax ID, including this one
Part of
Potomac Valley Hospital

Other organizations with this tax ID 27

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

View all 27

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Michael Joseph Gould Individual Corporate DirectorBoard Member Aug 10, 2021
Marjorie S Fridkin Individual Corporate DirectorBoard Member Sep 21, 2023
Kevin Clark Individual Corporate DirectorBoard Member Mar 27, 2018
Dinah Courrier Individual Corporate DirectorBoard Member Nov 20, 2019
Lewis Kitzmiller Individual Corporate DirectorBoard Member Jul 20, 2022
Brandon Combs Individual Corporate DirectorBoard Member Jan 27, 2025
West Virginia United Health System, Inc Organization, Morgantown, WV Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Jan 1, 2005 100%
Mark Boucot Individual Corporate DirectorCeo Jan 1, 2018
W-2 Managing EmployeeCeo Jan 1, 2018
Frances L Jones Individual Corporate DirectorBoard Member Nov 27, 2018
Sue a Wells Individual Corporate OfficerDir of Phys Prac MGMT Apr 3, 2014
W-2 Managing EmployeeDirector of Phys Prac MGMT Apr 3, 2014
Robin Haupt Individual Corporate DirectorBoard Member Sep 1, 2017
Amy L Boothe Individual Corporate OfficerVP Operations and Finance Jun 9, 2014
W-2 Managing EmployeeVP Operations and Finance Jun 9, 2014
Jennifer a Hensley Individual Corporate DirectorBoard Member Jul 1, 2025

Owners & managing parties with NPI records 3

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

Facilities with the same owner 52

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 52

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1576800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576800000000",
    "number": "1902444987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1370 JOHNSON AVE STE 102",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263301492",
            "telephone_number": "681-342-3453",
            "fax_number": "304-824-4233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10261 FRANKFORT HWY",
            "city": "FORT ASHBY",
            "state": "WV",
            "postal_code": "267194533",
            "telephone_number": "304-597-3600",
            "fax_number": "304-285-3963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTOMAC VALLEY HOSPITAL OF W VA , INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "POTOMAC VALLEY HOSPITAL OF W VA , INC",
        "enumeration_date": "2019-12-20",
        "last_updated": "2019-12-20",
        "certification_date": "2019-12-20",
        "status": "A",
        "authorized_official_last_name": "WELLS",
        "authorized_official_first_name": "SUE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "SENIOR DIRECTOR OF CLINIC OPERATION",
        "authorized_official_telephone_number": "304-597-3525"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fort Ashby Medical Center of Potomac Valley Hospital",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fort Ashby, WV

Sources for this page

Verify at the official NPI Registry.