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General NPI Number Information
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NPI Number | 1700270436
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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 | 03/19/2015
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Last Update Date | 03/19/2015
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Provider Practice Location Address
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Address Line | 142 N COURT SQUARE
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City | WEBSTER SPRINGS
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State | WV
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Zip | 26288
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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 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 | 364SP0200X
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Taxonomy Name | Pediatric Clinical Nurse Specialist
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License Number | 40555
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License Number State | WV
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