Provider Demographics
NPI:1083260129
Name:WILLIAMSON HEALTH & WELLNESS CENTER INC
Entity Type:Organization
Organization Name:WILLIAMSON HEALTH & WELLNESS CENTER INC
Other - Org Name:WILLIAMSON HEALTH & WELLNESS CENTER KERMIT PK8
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DONOVAN
Authorized Official - Last Name:BECKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-236-5902
Mailing Address - Street 1:PO BOX 2080
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-2080
Mailing Address - Country:US
Mailing Address - Phone:304-236-5902
Mailing Address - Fax:304-235-7041
Practice Address - Street 1:300 BLUE DEVIL LANE
Practice Address - Street 2:
Practice Address - City:KERMIT
Practice Address - State:WV
Practice Address - Zip Code:25661
Practice Address - Country:US
Practice Address - Phone:304-236-5902
Practice Address - Fax:304-235-7041
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLIAMSON HEALTH & WELLNESS CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-14
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)