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MOUNTAINEER FAMILY MEDICINE, INC.
NPI 1922848381
Family Medicine in Nitro, WV

Active since May 31, 2024CLIA 51D1075780 · Certificate of Compliance

NPPES record last updated: May 31, 2024. Verified against the NPPES registry weekly; last sync: August 30, 2026.

About Mountaineer Family Medicine, Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MOUNTAINEER FAMILY MEDICINE, INC. (NPI 1922848381) is a healthcare organization registered as a family medicine in Nitro, West Virginia and active in the NPI registry since May 2024. The organization holds a CLIA Certificate of Compliance certificate valid through September 15, 2027 and lists Victoria Warner, Billing Director, as its authorized official.

NPPES Registry Identity

NPI1922848381
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameMOUNTAINEER FAMILY MEDICINE, INC.
Location Address4114 1ST AVENitro, WV 25143-1304
Mailing Address5240 Maccorkle Ave SeCharleston, WV 25304-2122 · (681) 264-4986
Phone(304) 755-0119
Organization SubpartNo
Authorized OfficialVictoria WarnerBilling Director · (681) 264-4986
Enumeration DateMay 31, 2024
NPPES CertifiedMay 31, 2024
✔ NPI 1922848381 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
4114 1ST AVE, Nitro, WV 25143
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 51D1075780

Mountaineer Family Medicine Lab · Nitro, WV
Active · expires Sep 15, 2027
CLIA Number51D1075780
Laboratory TypePhysician Office
Certificate Effective DateSeptember 16, 2025
Certificate Expiration DateSeptember 15, 2027
Laboratory DirectorDr. Mohamad S. Kalou
Laboratory Phone(681) 217-1897
Laboratory LocationMountaineer Family Medicine Lab4114 1st Avenue, Nitro, WV 25143
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Waiver 51D2118170

Mountaineer Family Medicine Inc · Nitro, WV
Expired · Aug 31, 2026
CLIA Number51D2118170
Laboratory TypePhysician Office
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorMohamad Kalou
Laboratory Phone(304) 757-4007
Laboratory LocationMountaineer Family Medicine Inc4114 1st Avenue, Nitro, WV 25143
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KARLIE PERKINS
Nurse Practitioner (Family)
4114 1ST AVE
NITRO, WV 25143
Kanawha County (304) 755-0119
PHOENIX TREATMENT CENTER INC
Family Medicine (Adolescent Medicine)
4114 1ST AVE
NITRO, WV 25143
Kanawha County (304) 755-0119
BETSY DAWN LEGG FNP-MSN
Registered Nurse (School)
4114 1ST AVE
NITRO, WV 25143
Kanawha County (304) 755-0119
MODERN MEDICINE INC
Family Medicine
4114 1ST AVE
NITRO, WV 25143
Kanawha County (304) 755-0119

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mountaineer Family Medicine, Inc.'s NPI number?

The NPI number for Mountaineer Family Medicine, Inc. is 1922848381. It was assigned to this organization in the NPPES registry on May 31, 2024.

Where is Mountaineer Family Medicine, Inc. located?

Mountaineer Family Medicine, Inc. is located at 4114 1st Ave, Nitro, WV 25143. The listed phone number is (304) 755-0119.

What is Mountaineer Family Medicine, Inc.'s specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Mountaineer Family Medicine, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 51D1075780) is associated with this NPI, valid through September 15, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Mountaineer Family Medicine, Inc. was last updated on May 31, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.