PENDLETON COMMUNITY CARE INC. NPI 1417931379

NPI Information

  • NPI: 1417931379
  • Provider Name: PENDLETON COMMUNITY CARE, INC.
  • Classification: Clinic/Center - 261QF0400X
  • Specialization: Federally Qualified Health Center (FQHC)
  • Entity Type: Organization
  • Doing Business As: NORTH FORK PRIMARY CARE CLINIC
  • CLIA Number: 51D0661868
  • Address: 16921 MOUNTAINEER DRIVE
    RIVERTON, WV
    ZIP 26814
  • Phone: (304) 567-2101

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NPI Details

PENDLETON COMMUNITY CARE, INC. is a federally qualified health center (fqhc) clinic center in Riverton, WV. PENDLETON COMMUNITY CARE, INC. NPI is 1417931379. The provider is registered as an organization entity type.
The provider Is Doing Business As North Fork Primary Care Clinic.

The provider's business location address is:

16921 MOUNTAINEER DRIVE
RIVERTON, WV
ZIP 26814-101
Phone: (304) 567-2101
Fax: (304) 567-2102

The provider's authorized official is Jamie M Hudson .
The authorized official title is Ceo and has the following contact phone number (304) 358-7230.

The CLIA number assigned to this NPI record is 51D0661868 - federally qualified health center with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 12/5/2005 and was last updated on 7/19/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QF0400XClinic/CenterFederally Qualified Health Center (FQHC)Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
15369042000MEDICAIDWEST VIRGINIA
2511882MEDICARE OSCAR/CERTIFICATIONWEST VIRGINIA
35118821MEDICARE PINWEST VIRGINIA
4001706795OTHERWEST VIRGINIAMS BCBS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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