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General NPI Number Information
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NPI Number | 1134197882
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Entity Type | Organization
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Legal Business Name | SUMMERSVILLE PEDIATRICS INC.
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 09/19/2007
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Provider Practice Location Address
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Address Line | 400 FAIRVIEW HEIGHTS RD SUITE 302
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City | SUMMERSVILLE
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State | WV
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Zip | 26651-9308
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Country | US
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Telephone | 304-872-7063
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Fax | 304-872-7080
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Provider Business Mailing Address
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Address Line | 400 FAIRVIEW HEIGHTS RD SUITE 302
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City | SUMMERSVILLE
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State | WV
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Zip | 26651-9308
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Country | US
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Telephone | 304-872-7063
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Fax | 304-872-7080
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JOYCE A MCCLUNG
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Credential |
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Telephone | 304-872-7063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 01157
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License Number State | WV
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