NPIMap

Organization Active NPI

South Harrison Family Medicine

  • Family Medicine Physician
  • Lost Creek, WV
National Provider Identifier
1922197573
Registry record updated Dec 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
15551 Issued in WV
Legal business name
SOUTH HARRISON FAMILY MEDICINE
Practice address
2324 Hawk Highway
Lost Creek, WV 26385-9707
Phone
(304) 745-3200
Fax
(304) 745-4068
NPI assigned
Oct 12, 2006
Last updated
Dec 5, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2011

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

Authorized official

Name
Dr. Jo Ann Longenecker, MDNPI 1548359193
Title
President
Phone
(304) 745-3200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 15551 WV Primary

Addresses

Primary practice location

2324 Hawk Highway
Lost Creek, WV 26385-9707

Mailing address

2324 Hawk Highway
Lost Creek, WV 26385-9707
Phone (304) 745-3200

Other identifiers 1

IdentifierTypeStateIssuer
0007163000MedicaidWV

National Provider Directory

National Provider Directory

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": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323043200000",
    "number": "1922197573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2324 HAWK HIGHWAY",
            "city": "LOST CREEK",
            "state": "WV",
            "postal_code": "263859707",
            "telephone_number": "304-745-3200",
            "fax_number": "304-745-4068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2324 HAWK HIGHWAY",
            "city": "LOST CREEK",
            "state": "WV",
            "postal_code": "263859707",
            "telephone_number": "304-745-3200",
            "fax_number": "304-745-4068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH HARRISON FAMILY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2011-12-05",
        "status": "A",
        "authorized_official_last_name": "LONGENECKER",
        "authorized_official_first_name": "JO",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-745-3200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "15551",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0007163000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lost Creek, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2011; 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.