LIVING WATERS MEDICAL CENTER (NPI# 1114585619) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1114585619 |
Entity Type | Organization |
Organization Name | LIVING WATERS MEDICAL CENTER |
Practice Address |
100 Main Ave Logan WV 25601-3323 |
Practice Telephone | 3049468350 |
Enumeration Date | 2019-05-31 |
Last Update Date | 2019-05-31 |
Authorized Official Name | MRS. AMBER ELLIS (DIRECTOR/FAMILY NURSE PRACTITIONER) |
Authorized Official Telephone | 3049468350 |
Authorized Official Credential | APRN |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
Street Address |
100 MAIN AVE |
City | LOGAN |
State | WV |
Zip Code | 25601-3323 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1982915575 | Jamie Leann Hall-jasper | Podiatrist | 100 Main Ave, Logan, WV 25601-3323 | 2010-06-29 |
1215334966 | Logan Foot & Ankle Center | Clinic/Center | 100 Main Ave, Logan, WV 25601-3323 | 2014-11-24 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1720689805 | Appalachian Medical LLC | Durable Medical Equipment & Medical Supplies | 218 Dingess St, Logan, WV 25601 | 2020-11-04 |
1184224909 | Pamela Gail Hamlin | Technician | 123 Cassick Street, Logan, WV 25601 | 2020-10-30 |
1134607344 | Allyson Christa Mckinney | Occupational Therapy Assistant | 55 Lmmh Center Road, Logan, WV 25601 | 2018-07-31 |
1841783727 | Erica Lupson | Nurse Practitioner | 3 Mile Curve, Logan, WV 25601 | 2018-06-14 |
1861930836 | Joseph Michael Mounts | Counselor | 312 Hudgins St, Logan, WV 25601 | 2017-02-09 |
1932647385 | Melissa Campbell | Occupational Therapy Assistant | Wv-10, Logan, WV 25601 | 2017-02-06 |
1356891659 | Brooke Bell | Pharmacist | Route 44 Holden Rd, Logan, WV 25601 | 2016-10-11 |
1760886469 | April Workman | Massage Therapist | 19 A Main Avenue, Logan, WV 25601 | 2014-10-09 |
1366889081 | Ashley Leann Dingess | Physical Therapy Assistant | 55 Logan Mingo Mental Health, Logan, WV 25601 | 2013-06-04 |
1528361466 | Health Care Management, LLC | Pharmacy | 369 George Kostas Drive, Logan, WV 25601 | 2010-12-15 |
Find all providers in zip 25601 |
Taxonomy Code | 261QP2300X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Primary Care |
Definition to come... |
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1659724524 | Norton County Hospital | Clinic/Center | 214 W Main St, Logan, KS 67646-9764 | 2016-07-15 |
1912368549 | Sage Functional Medicine Center | Clinic/Center | 55 E 100 N, Suite 303, Logan, UT 84321-4661 | 2016-03-09 |
1477926806 | Remack LLC | Clinic/Center | 2380 N 400 E, Ste C, Logan, UT 84341-6000 | 2015-11-06 |
1316329220 | Jacob Douglas Anderson | Clinic/Center | 630 E 1400 N Ste 150, Logan, UT 84341-2549 | 2015-06-26 |
1104220409 | Ohio Valley Physicians, Inc | Clinic/Center | 557 Main St, Logan, WV 25601-3809 | 2014-10-15 |
1952716755 | Bruce A Isaacson Md PC | Clinic/Center | 550 E 1400 N, Suite Z, Logan, UT 84341-2406 | 2014-07-01 |
1881781144 | Hopewell Health Centers Inc | Clinic/Center | 30381 Chieftain Drive, Logan, OH 43138-1013 | 2006-10-06 |
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1306330345 | Kingwood Family Care, LLC | Clinic/Center | 17548 Veterans Memorial Highway, Suite D, Kingwood, WV 26537 | 2018-06-21 |
1588039242 | Summersville Outpatient Center | Clinic/Center | 100 Florence Street, Ansted, WV 25812 | 2015-12-07 |
1801283882 | Mingo County Family Wellness Center LLC | Clinic/Center | 50 Lenore Business Center, Williamson, WV 25661 | 2015-04-17 |
1639412398 | Potomac Integrative Health Pllc | Clinic/Center | 51 Maddex Square Drive, Shepherdstown, WV 25443-4310 | 2013-04-01 |
1831447499 | William Conrad Inc. | Clinic/Center | 154 Oak View Ln, New Creek, WV 26743-4544 | 2012-08-29 |
1548518095 | Charles Town Health Right, Inc | Clinic/Center | 1212 N. Mildred St., Ranson, WV 25438-5552 | 2012-08-15 |
1154676096 | Mebrahtom Tesfai Pllc | Clinic/Center | 212 Professional Park, Beckley, WV 25801-3624 | 2012-07-17 |
1679832646 | Health Thru Care, LLC | Clinic/Center | 1397 Earl L. Core Road, Sabraton Plaza, Morgantown, WV 26505 | 2012-05-11 |
1811261225 | Bruceton Medical Center | Clinic/Center | 198 Morgantown Street, Suite B, Bruceton Mills, WV 26525 | 2012-03-02 |
1629364351 | Spring Valley Family Care | Clinic/Center | 27 Springfield Pike, Springfield, WV 26763 | 2011-06-21 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.