1295865954 NPI number — ROSS SUMMERS MD PLLC

Table of content: (NPI 1295865954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295865954 NPI number — ROSS SUMMERS MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSS SUMMERS MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MEDICAL CLINIC OF NORTHVILLE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295865954
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
308 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHVILLE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48167-1646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-349-0627
Provider Business Mailing Address Fax Number:
248-380-9365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
308 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHVILLE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48167-1646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-349-0627
Provider Business Practice Location Address Fax Number:
248-380-9365
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SUMMERS
Authorized Official First Name:
ROSS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
248-349-0627

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  4301074604 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 4301057732 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 4301071154 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 4301082667 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 4301068380 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 4301058039 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 4301046792 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CB2510 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0H24993 . This is a "MI BLUE CROSS AND BLUE SH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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