Healthcare Provider Details

I. General information

NPI: 1174513808
Provider Name (Legal Business Name): SUMMERSVILLE REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 FAIRVIEW HEIGHTS RD
SUMMERSVILLE WV
26651-9308
US

IV. Provider business mailing address

400 FAIRVIEW HEIGHTS RD
SUMMERSVILLE WV
26651-9308
US

V. Phone/Fax

Practice location:
  • Phone: 304-872-2891
  • Fax: 304-872-6854
Mailing address:
  • Phone: 304-872-2891
  • Fax: 304-872-6854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number61
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number61
License Number StateWV

VIII. Authorized Official

Name: DEBORAH ALICE KINCELL
Title or Position: REVENUE CYCLE DIRECTOR
Credential:
Phone: 304-883-0252