ST GEORGE MEDICAL CLINIC INC (NPI# 1891176137) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891176137 |
| Entity Type | Organization |
| Organization Name | ST GEORGE MEDICAL CLINIC INC |
| Practice Address |
81 Tucker Valley School Rd Hambleton WV 26269-8052 |
| Mailing Address |
6420 Holly Meadows Rd Parsons WV 26287-8055 |
| Practice Telephone | 3044783339 |
| Mailing Telephone | 3044783339 |
| Mailing Fax Number | 3044783311 |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2015-06-12 |
| Authorized Official Name | MR. PAUL H WAMSLEY JR. (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 3044783339 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UNKNOW | 00000 | 01 |
| Street Address |
81 TUCKER VALLEY SCHOOL RD |
| City | HAMBLETON |
| State | WV |
| Zip Code | 26269-8052 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790103687 | Tucker County Health Department | Public Health or Welfare | 219 Sunnyside Lane, Parsons, WV 26269 | 2014-03-28 |
| 1154749604 | Tucker County Health Department | Public Health or Welfare | 219 Sunnyside Lane, Parsons, WV 26269 | 2014-04-02 |
| 1457961849 | Danielle Lynn Arman | Homemaker | 32 6th St, Hambleton, WV 26269-1101 | 2020-07-31 |
| 1700399482 | Loretta Wanda Pennington | Technician | 181 Rabbit Run Rd, Hambleton, WV 26269-8020 | 2017-11-16 |
| 1164882072 | Karen Goff | General Acute Care Hospital | 42 Pineview Flats Rd, Hambleton, WV 26269-8037 | 2016-03-04 |
| 1639777436 | Krista Heckler | Technician | 267 Redtail Ln, Hambleton, WV 26269-8095 | 2020-10-14 |
| 1063023307 | Sharon P. Hinkle | Technician | 20 Wild Maggie Way, Hambleton, WV 26269-8166 | 2020-08-11 |
| 1659979458 | Kaitlynn Barkley | Technician | 82 Blackman Flats Rd, Hambleton, WV 26269-8173 | 2020-10-14 |
| 1063886182 | Heather Eye | Physician Assistant | 138 Crestview Dr, Hambleton, WV 26269-8195 | 2015-12-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639777436 | Krista Heckler | Technician | 267 Redtail Ln, Hambleton, WV 26269-8095 | 2020-10-14 |
| 1659979458 | Kaitlynn Barkley | Technician | 82 Blackman Flats Rd, Hambleton, WV 26269-8173 | 2020-10-14 |
| 1003427048 | Deanna Eloise Summerfield | Technician | 44 Blue Bird Alley, Hambleton, WV 26267 | 2020-08-13 |
| 1063023307 | Sharon P. Hinkle | Technician | 20 Wild Maggie Way, Hambleton, WV 26269-8166 | 2020-08-11 |
| 1457961849 | Danielle Lynn Arman | Homemaker | 32 6th St, Hambleton, WV 26269-1101 | 2020-07-31 |
| 1700399482 | Loretta Wanda Pennington | Technician | 181 Rabbit Run Rd, Hambleton, WV 26269-8020 | 2017-11-16 |
| 1164882072 | Karen Goff | General Acute Care Hospital | 42 Pineview Flats Rd, Hambleton, WV 26269-8037 | 2016-03-04 |
| 1063886182 | Heather Eye | Physician Assistant | 138 Crestview Dr, Hambleton, WV 26269-8195 | 2015-12-01 |
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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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.