Healthcare Provider Details

I. General information

NPI: 1477569101
Provider Name (Legal Business Name): SUMMERSVILLE REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/14/2016
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: 304-872-8437
  • Fax: 304-872-8468
Mailing address:
  • Phone: 304-872-8481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberOP552214
License Number StateWV

VIII. Authorized Official

Name: TERESA TAYLOR
Title or Position: PIC
Credential:
Phone: 304-872-8481