Provider Demographics
NPI:1447684006
Name:SUMMERSVILLE UROLOGY ASSOCIATES, INC.
Entity type:Organization
Organization Name:SUMMERSVILLE UROLOGY ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:MERIWETHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-645-4043
Mailing Address - Street 1:PO BOX 1049
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-4049
Mailing Address - Country:US
Mailing Address - Phone:304-645-4043
Mailing Address - Fax:304-645-4713
Practice Address - Street 1:315 FAIRVIEW HEIGHTS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1086
Practice Address - Country:US
Practice Address - Phone:304-872-8424
Practice Address - Fax:304-883-2383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-30
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV14677208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty