1164703476 NPI number — SUMMIT PAIN SPECIALISTS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164703476 NPI number — SUMMIT PAIN SPECIALISTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMMIT PAIN SPECIALISTS, INC.
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:
SUMMIT PAIN SPECIALISTS PHARMACY
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:
1164703476
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4302 ALLEN RD STE 300
Provider Second Line Business Mailing Address:
4302 ALLEN RD SUITE 301
Provider Business Mailing Address City Name:
STOW
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44224-1070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-945-7246
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4302 ALLEN RD STE 300
Provider Second Line Business Practice Location Address:
4302 ALLEN RD SUITE 301
Provider Business Practice Location Address City Name:
STOW
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44224-1070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-945-7246
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WOOD
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
330-945-4346

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  022097600 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3679896 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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