NPIMap

Organization Active NPI

Preston Taylor Community Health Centers, Incorporated

  • Federally Qualified Health Center (FQHC)
  • Grafton, WV
National Provider Identifier
1992813604
Registry record updated Feb 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PRESTON TAYLOR COMMUNITY HEALTH CENTERS, INCORPORATED
Practice address
725 North Pike Street
Grafton, WV 26354-1270
Phone
(304) 265-4909
Fax
(304) 265-4915
NPI assigned
Aug 25, 2006
Organization subpart
Yes
Parent organization
PRESTON TAYLOR COMMUNITY HEALTH CENTERS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 15, 2022

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

Authorized official

Name
Beverly J. Snyder
Title
Executive Assistant/Access Manager
Phone
(304) 265-0312

Specialties & licenses 1

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

Addresses

Primary practice location

725 North Pike Street
Grafton, WV 26354-1270

Mailing address

25 W Bluemont St
Grafton, WV 26354-1242
Phone (304) 265-0312

Other identifiers 1

IdentifierTypeStateIssuer
0035347000MedicaidWV

Other names 1

  • Medical Center of Taylor County Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040209000039 WV Part B Supplier - Public Health/Welfare Agency 3072406438 Receives reassigned benefits from 20 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Newburg, WV; Thomas, WV; Rowlesburg, WV; Mount Storm, WV; Grafton, WV; Eglon, WV
O20090507000622 WV Part A Provider - Federally Qualified Health Center (FQHC) 3072406438 Practice locations: Grafton, WV

Federally qualified health center certification: CCN 511861

Legal name
PRESTON TAYLOR COMMUNITY HEALTH CENTERS, INCORPORATED
Doing business as
MEDICAL CENTER OF TAYLOR COUNTY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 1, 1997
Last certification
Jun 1, 1997
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 1987 in WV
Enrollment address
725 N Pike St
Grafton, WV 26354-1270

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Community Eye Care

Locations

670 Spring Hills Rd
Grafton, WV 26354
Phone (304) 265-0722

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Vonda Reneman Individual Corporate DirectorBoard Member Jan 1, 2019
Beverly J Snyder Individual W-2 Managing EmployeeExecutive Assistant Jan 23, 2014
Elizabeth June Griffith Individual 5% Or Greater Indirect Ownership Interest Jan 16, 2022
Corporate OfficerChief Executive Officer Jan 16, 2022 100%
W-2 Managing Employee Jan 16, 2022 100%
Doug Lyons Individual Corporate DirectorBoard Member Sep 21, 2009
Patrick a Nichols Individual Corporate DirectorBoard Member Sep 27, 2001
Mary Kay Dean Individual Corporate DirectorBoard Member Jan 1, 2018
Tony Veltri Individual Corporate DirectorBoard Member Jun 1, 1986
Hunter B Mullens Individual Corporate DirectorBoard Member Jun 25, 1997

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Community Eye CareGrafton, WV, CCN 581043 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Mar 1, 2024
Mar 1, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644883200000",
    "number": "1992813604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 W BLUEMONT ST",
            "city": "GRAFTON",
            "state": "WV",
            "postal_code": "263541242",
            "telephone_number": "304-265-0312",
            "fax_number": "304-265-0314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 NORTH PIKE STREET",
            "city": "GRAFTON",
            "state": "WV",
            "postal_code": "263541270",
            "telephone_number": "304-265-4909",
            "fax_number": "304-265-4915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTON TAYLOR COMMUNITY HEALTH CENTERS, INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRESTON TAYLOR COMMUNITY HEALTH CENTERS INC",
        "enumeration_date": "2006-08-25",
        "last_updated": "2022-02-15",
        "certification_date": "2022-02-15",
        "status": "A",
        "authorized_official_last_name": "SNYDER",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "EXECUTIVE ASSISTANT/ACCESS MANAGER",
        "authorized_official_telephone_number": "304-265-0312"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0035347000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Center of Taylor County",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Medical Center of Taylor County",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grafton, WV

Sources for this page

Verify at the official NPI Registry.