Wvdhhr John Manchin Sr. Health Care Center

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

Legal business name

WVDHHR JOHN MANCHIN SR. HEALTH CARE CENTER

Practice address

401 Guffey Street
Fairmont, WV 26554-6554

Phone

(304) 363-2500

Fax

(304) 363-0263

NPI assigned

Nov 6, 2014

Organization subpart

No

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

Authorized official

Name

Carol Diana Merrill, NHA CEO

Title

Administrator

Phone

(304) 363-2500

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Wvdhhr John Manchin Sr Health Care Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Wvdhhr John Manchin Sr Health Care Center

  • Family Medicine Physician
  • Fairmont, WV
  • NPI 1417963000
  NPD tax ID

Practitioners 1

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

• James Namsupak, M.D.

  • General Practice Physician
  • Fairmont, WV
  • NPI 1043486145
  NPD (past)

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

{
    "created_epoch": "1415232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415232000000",
    "number": "1922404649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 GUFFEY STREET",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265546554",
            "telephone_number": "304-363-2500",
            "fax_number": "304-363-0263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 GUFFEY STREET",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265546554",
            "telephone_number": "304-363-2500",
            "fax_number": "304-363-0263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WVDHHR JOHN MANCHIN SR. HEALTH CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-06",
        "last_updated": "2014-11-06",
        "status": "A",
        "authorized_official_last_name": "MERRILL",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "DIANA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "304-363-2500",
        "authorized_official_credential": "NHA CEO"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "WV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0004092000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly R Wright, MS, PT
• Greg Joseph Wrobleski, DDS
• Alexis Nicole Wunderlich, OTR/L
• WV Durable Medical Equipment Co, LLC
• Wvdhhr John Manchin Sr Health Care Center
• Tenille Wyer
• Jennifer Wyne
• Yale Academy LLC
• April Yanero
• Larinda Yelcich

• All providers in Fairmont, WV
• Nursing Facility/Intermediate Care Facility in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2014; 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.