MEDICARE: SUMMERSVILLE OUTPATIENT CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician

General Provider Information

NPI Number	:	1619410693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMERSVILLE OUTPATIENT CENTER

Provider Business Mailing Address
First Line	:	400 FAIRVIEW HEIGHTS RD
Second Line	:
City	:	SUMMERSVILLE
State	:	WV
Zip	:	26651-9308
Country	:	US
Telephone Number	:	304-883-0220
Fax Number	:	304-872-6854

Provider Business Practice Location Address
First Line	:	702 PROFESSIONAL PARK DR
Second Line	:
City	:	SUMMERSVILLE
State	:	WV
Zip	:	26651-2018
Country	:	US
Telephone Number	:	304-883-2380
Fax Number	:	304-872-6854

Authorized Official
Title or Position	:	REVENUE CYCLE DIRECTOR
Name	:	DEBORAH KINCELL
Credential	:
Telephone Number	:	304-883-0220

Provider Enumeration Date	:	11/23/2016
Last Update Date	:	11/23/2016

Similar Medicare Providers

1023122041 — ROBERT CHARLES STANLEY D.O.
Practice Location Address:

702 PROFESSIONAL PARK DR , SUITE 100
SUMMERSVILLE, WV
26651-2018

Practice Phone: 304-872-2991
Practice Fax: 304-872-6268

1609904663 — JOHN LACKEY, INC
Practice Location Address:

702 PROFESSIONAL PARK DR , SUITE102
SUMMERSVILLE, WV
26651-2018

Practice Phone: 304-872-6433
Practice Fax: 304-872-6562

1205951605 — DR JOHN LACKEY INC
Practice Location Address:

702 PROFESSIONAL PARK DR , SUITE 102
SUMMERSVILLE, WV
26651-2018

Practice Phone: 304-872-6433
Practice Fax: 304-872-6562

1992244081 — SUMMERSVILLE OUTPATIENT CENTER
Practice Location Address:

702 PROFFESSIONAL PARK DR
SUMMERSVILLE, WV
26651-2018

Practice Phone: 304-883-2381
Practice Fax: 304-883-2383

1982133898 — MISS ASHLEY RUDD
Practice Location Address:

400 FAIRVIEW HEIGHTS RD
SUMMERSVILLE, WV
26651-9308

Practice Phone: 304-872-8629
Practice Fax: 304-872-8423

1811844210 — WHOLE HEALTH MEDICAL AND MENTAL WELLNESS, LLC
Practice Location Address:

72 OAKGROVE CUTOFF RD
SUMMERSVILLE, WV
26651-4924

Practice Phone: 304-237-8806
Practice Fax:

Directions to “SUMMERSVILLE OUTPATIENT CENTER ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.