Basic Information
| Provider Information | |||||||||
| NPI: | 1164401147 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMMERS | ||||||||
| FirstName: | SHERRIAL | ||||||||
| MiddleName: | RENAY | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 6 GREAT TEAYS BLVD | ||||||||
| Address2: | |||||||||
| City: | SCOTT DEPOT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047576999 | ||||||||
| FaxNumber: | 3047573252 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 5TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | CHARLESTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044144499 | ||||||||
| FaxNumber: | 3044144498 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 03/18/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 1834 | WV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7398338 | 01 | WV | AETNA | OTHER | 001721068 | 01 | WV | MS BCBS | OTHER | 1840696000 | 05 | WV | MEDICAID |