Provider Demographics
NPI:1750332524
Name:UNITED SUMMIT CENTER INC
Entity Type:Organization
Organization Name:UNITED SUMMIT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-623-5661
Mailing Address - Street 1:6 HOSPITAL PLZ
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-9316
Mailing Address - Country:US
Mailing Address - Phone:304-598-6280
Mailing Address - Fax:304-623-2989
Practice Address - Street 1:6 HOSPITAL PLZ
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-9316
Practice Address - Country:US
Practice Address - Phone:304-623-5661
Practice Address - Fax:304-623-2989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0005239000Medicaid
WV0005239002Medicaid
WV0017100654OtherBLUE CROSS BLUE SHIELD
WV001710655OtherBLUE CROSS BLUE SHIELD
WV0018101987OtherBLUE CROSS BLUE SHIELD
WV0005239001Medicaid
WVUN9289344Medicare ID - Type UnspecifiedMEDICARE/GILMER
WVUN9289343Medicare ID - Type UnspecifiedMEDICARE/BRAXTON
WV0005239000Medicaid
WV0017100654OtherBLUE CROSS BLUE SHIELD