1235223249 NPI number — SUMMA PHYSICIANS, 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 1235223249 NPI number — SUMMA PHYSICIANS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMMA PHYSICIANS, 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:
SUMMA HEALTH MEDICAL GROUP
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:
1235223249
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1077 GORGE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44310-2408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
234-312-5691
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 5TH ST NE STE 16
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARBERTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44203-3017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-615-3070
Provider Business Practice Location Address Fax Number:
234-312-2427
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROOD
Authorized Official First Name:
GINA
Authorized Official Middle Name:
Authorized Official Title or Position:
SR IT SYSTEMS ANALYST
Authorized Official Telephone Number:
234-312-5193

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0412873 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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