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General NPI Number Information
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NPI Number | 1750378345
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Entity Type | Organization
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Legal Business Name | SUMMERSVILLE OUT PATIENT CENTER
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 09/22/2010
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Provider Practice Location Address
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Address Line | 400 FAIRVIEW HEIGHTS RD
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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 | 304-872-5124
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Fax | 304-872-0675
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Provider Business Mailing Address
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Address Line | 400 FAIRVIEW HEIGHTS RD
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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 | 304-872-5124
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Fax | 304-872-0675
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Authorized Official
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Title or Position | CEO
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Name | DEBBIE HILL
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Credential | MBA
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Telephone | 304-872-8402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 51D0933140
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 61
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 61
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License Number State | WV
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