Mountain State Urgent Care

Primary specialty

Urgent Care Clinic/CenterTaxonomy code 261QU0200X

Legal business name

MOUNTAIN STATE URGENT CARE

Practice address

4089 Webster Rd
Summersville, WV 26651-7200

Phone

(304) 900-2591

Fax

(800) 397-1586

NPI assigned

Jan 24, 2022

Organization subpart

No

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

Authorized official

Name

Dr. William R Carson, M.D.NPI 1851445225

Title

President

Phone

(304) 900-2589

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 2

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

• William R Carson, M.D.

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Summersville, WV
  • NPI 1851445225

  Single Specialty

  Medicare reassignment NPD Authorized official
• Heather Dawn O'Dell, FNP

  • Family Nurse Practitioner
  • Oak Hill, WV
  • NPI 1992078380
  Medicare reassignment NPD

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

{
    "created_epoch": "1642982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710288000000",
    "number": "1992457741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4089 WEBSTER RD",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "266517200",
            "telephone_number": "304-900-2589",
            "fax_number": "800-397-1586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4089 WEBSTER RD",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "266517200",
            "telephone_number": "304-900-2591",
            "fax_number": "800-397-1586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATE URGENT CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-24",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A",
        "authorized_official_last_name": "CARSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-900-2589",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207XX0801X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Orthopaedic Trauma",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mountain Lake Pharmacy Inc
• Mountain Light Mental Health LLC
• Mountain Ridge Dialysis LLC
• Mountain State Orthopedics & Sports Medicine
• Mountain State Orthopedics and Sports Medicine
• Mountain Transit Authority
• Mountaineer Physical Therapy & Sports Medicine
• Lisa Dawn Mowery
• Christina Marie Moyers, MS, RD, LD
• Casandra June Mullens, PRSS

• Urgent Care Clinic/Center in Summersville, WV
• Providers in Summersville, WV by specialty
• Urgent Care Clinic/Center in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.