NPIMap

Organization Active NPI

St Charles Health Council Inc

Doing business as Coeburn Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Coeburn, VA
National Provider Identifier
1942322003
Registry record updated Oct 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ST CHARLES HEALTH COUNCIL INC
Doing business as
Coeburn Family Health Center
Practice address
815 4A Laurel Avenue
Coeburn, VA 24230
Phone
(276) 565-2764
Fax
(276) 395-6990
NPI assigned
Apr 6, 2007
Last updated
Oct 28, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2016

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

Authorized official

Name
Malcolm Perdue
Title
Chief Executive Officer
Phone
(276) 546-5310

Specialties & licenses 1

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

Addresses

Primary practice location

815 4A Laurel Avenue
Coeburn, VA 24230

Mailing address

815 4A Laurel Avenue
Coeburn, VA 24230
Phone (276) 565-2764

Other identifiers 1

IdentifierTypeStateIssuer
010376017MedicaidVA

Other names 1

  • Coeburn Family Health Center Doing business as

National Provider Directory

National Provider Directory

Locations

507 W Main St
Appalachia, VA 24216
Phone (276) 565-2760

536 E Main St
Appalachia, VA 24216
Phone (276) 565-2760

10279 Hurley Rd
Hurley, VA 24620
Phone (276) 566-7204

127 Health Care Dr
Ste 12
Pennington Gap, VA 24277
Phone (276) 546-3001

241 Monarch Rd
Saint Charles, VA 24282
Phone (276) 383-4428

1721 Lovers Gap Rd
Vansant, VA 24656
Phone (276) 597-7081

Practitioners & affiliated clinicians

Practitioners 48

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 48

NPI Registry JSON

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477612800000",
    "number": "1942322003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 4A LAUREL AVENUE",
            "city": "COEBURN",
            "state": "VA",
            "postal_code": "24230",
            "telephone_number": "276-565-2764",
            "fax_number": "276-395-6990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 4A LAUREL AVENUE",
            "city": "COEBURN",
            "state": "VA",
            "postal_code": "24230",
            "telephone_number": "276-565-2764",
            "fax_number": "276-395-6990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST CHARLES HEALTH COUNCIL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2016-10-28",
        "status": "A",
        "authorized_official_last_name": "PERDUE",
        "authorized_official_first_name": "MALCOLM",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "276-546-5310"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010376017",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coeburn Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coeburn, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2016; 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.