Provider Demographics
NPI:1295274538
Name:BELINGTON COMMUNITY MEDICAL SERVICES ASSOCIATION
Entity type:Organization
Organization Name:BELINGTON COMMUNITY MEDICAL SERVICES ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-457-0063
Mailing Address - Street 1:116 MCCLELLAN RD
Mailing Address - Street 2:
Mailing Address - City:PHILIPPI
Mailing Address - State:WV
Mailing Address - Zip Code:26416-8076
Mailing Address - Country:US
Mailing Address - Phone:304-457-2800
Mailing Address - Fax:304-457-4011
Practice Address - Street 1:116 MCCLELLAN RD
Practice Address - Street 2:
Practice Address - City:PHILIPPI
Practice Address - State:WV
Practice Address - Zip Code:26416-8076
Practice Address - Country:US
Practice Address - Phone:304-457-2800
Practice Address - Fax:304-457-4011
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELINGTON COMMUNITY MEDICAL SERVICES ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-20
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV103T00000X, 363A00000X, 363L00000X, 261QF0400X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0315003000Medicaid