NPIMap

Organization Active NPI

Summersville Pediatrics, Inc.

  • Pediatrics Physician
  • Ansted, WV
National Provider Identifier
1134464290
Registry record updated Mar 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
01157 Issued in WV
Legal business name
SUMMERSVILLE PEDIATRICS, INC.
Practice address
101 Florence Street
Ansted, WV 25812
Phone
(304) 872-7063
Fax
(304) 872-7080
NPI assigned
Nov 30, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joyce McClung
Title
Office Manager
Phone
(304) 872-7063

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 01157 WV Primary

Addresses

Primary practice location

101 Florence Street
Ansted, WV 25812

Mailing address

400 Fairview Heights Rd
Suite 302
Summersville, WV 26651-9308
Phone (304) 872-7063

National Provider Directory

National Provider Directory
Tax ID family
Summersville Pediatrics Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1354233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426809600000",
    "number": "1134464290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 FAIRVIEW HEIGHTS RD",
            "address_2": "SUITE 302",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "266519308",
            "telephone_number": "304-872-7063",
            "fax_number": "304-872-7080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 FLORENCE STREET",
            "city": "ANSTED",
            "state": "WV",
            "postal_code": "25812",
            "telephone_number": "304-872-7063",
            "fax_number": "304-872-7080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMERSVILLE PEDIATRICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-30",
        "last_updated": "2015-03-20",
        "status": "A",
        "authorized_official_last_name": "MCCLUNG",
        "authorized_official_first_name": "JOYCE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "304-872-7063"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "WV",
            "license": "01157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ansted, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.