Organization Name: | SUMMERSVILLE PEDIATRICS, INC. |
NPI Number: | 1700270436 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOYCE MCCLUNG (OFFICE MANAGER) |
Mailing Address: | 142 N Court Square Webster Springs |
State: | WV US |
Postal Code: | 26288 |
Phone Number: | 3048727063 |
Fax Number: | 3048727080 |
NPI Enumeration Date: | 03/19/2015 |
NPI Last Update Date: | 03/19/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 364SP0200X |
License Number: | 40555 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Clinical Nurse Specialist |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |