NPIMap

Organization Active NPI

Summersville Outpatient Center

  • Urology Physician
  • Summersville, WV
National Provider Identifier
1619410693
Registry record updated Nov 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
SUMMERSVILLE OUTPATIENT CENTER
Practice address
702 Professional Park Dr
Summersville, WV 26651-2018
Phone
(304) 883-2380
Fax
(304) 872-6854
NPI assigned
Nov 23, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2016

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

Authorized official

Name
Deborah Kincell
Title
Revenue Cycle Director
Phone
(304) 883-0220

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208800000X Primary

Addresses

Primary practice location

702 Professional Park Dr
Summersville, WV 26651-2018

Mailing address

400 Fairview Heights Rd
Summersville, WV 26651-9308
Phone (304) 883-0220

Other names 1

  • Summersville Urology Clinic Other name

National Provider Directory

National Provider Directory
Tax ID family
Summersville Outpatient4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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": "1479859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479859200000",
    "number": "1619410693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 FAIRVIEW HEIGHTS RD",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "266519308",
            "telephone_number": "304-883-0220",
            "fax_number": "304-872-6854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 PROFESSIONAL PARK DR",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "266512018",
            "telephone_number": "304-883-2380",
            "fax_number": "304-872-6854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMERSVILLE OUTPATIENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-23",
        "last_updated": "2016-11-23",
        "status": "A",
        "authorized_official_last_name": "KINCELL",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "REVENUE CYCLE DIRECTOR",
        "authorized_official_telephone_number": "304-883-0220"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Summersville Urology Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Summersville, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2016; 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.