Healthcare Provider Details

I. General information

NPI: 1033481585
Provider Name (Legal Business Name): SUMMIT HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31452 VETERANS MEMORIAL HWY
TERRA ALTA WV
26764-9715
US

IV. Provider business mailing address

31452 VETERANS MEMORIAL HWY
TERRA ALTA WV
26764-9715
US

V. Phone/Fax

Practice location:
  • Phone: 304-290-7508
  • Fax: 304-789-3195
Mailing address:
  • Phone: 304-290-7508
  • Fax: 304-789-3195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number27929
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number30529
License Number StateWV

VIII. Authorized Official

Name: MRS. MARY ANN WHITEHAIR
Title or Position: OWNER
Credential: CRNP
Phone: 304-290-7508