Living Waters Medical Center
NPI 1114585619 · Primary Care Clinic/Center · Logan, WV
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Living Waters Medical Center is a Primary Care Clinic/Center organization in Logan, WV (NPI 1114585619).
Provider details
- NPI number
- 1114585619
- Entity type
- Organization
- Primary specialty
- Primary Care Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Amber Ellis, Director/Family Nurse Practitioner(304) 946-8350
Specialties & taxonomies
Ambulatory Health Care Facilities
Behavioral Health & Social Service Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
7 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2019-05-31
- Last updated
- 2025-03-26
- Certified
- 2025-03-26
Frequently asked questions
- What is Living Waters Medical Center's NPI number?
- Living Waters Medical Center's National Provider Identifier (NPI) is 1114585619, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Living Waters Medical Center?
- Living Waters Medical Center is classified in the NPPES registry as Primary Care Clinic/Center (Ambulatory Health Care Facilities).
- Where is Living Waters Medical Center located?
- Living Waters Medical Center's practice location on file with NPPES is 100 Main Ave, Logan, WV 25601-3323.
- What is Living Waters Medical Center's phone number?
- The practice phone number listed in the NPPES registry for Living Waters Medical Center is (304) 946-8350.
- Does Living Waters Medical Center accept Medicare?
- Living Waters Medical Center is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Living Waters Medical Center?
- The authorized official listed on Living Waters Medical Center's NPPES record is Amber Ellis, Director/Family Nurse Practitioner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Living Waters Medical Center's NPI active?
- Yes — Living Waters Medical Center's NPI (1114585619) is active in the NPPES registry as of the last update on 2025-03-26.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.