1356574560 NPI number — SUMMIT MEDICAL CENTER

Table of content: (NPI 1356574560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356574560 NPI number — SUMMIT MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMMIT MEDICAL CENTER
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 MEDICAL CENTER, LLC
Provider Other Organization Name Type Code:
4
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:
1356574560
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 269083
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-359-2400
Provider Business Mailing Address Fax Number:
405-359-9186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 S. RENAISSANCE BLVD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDMOND
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73013-3023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-359-2400
Provider Business Practice Location Address Fax Number:
405-359-9186
Provider Enumeration Date:
09/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT
Authorized Official Telephone Number:
405-359-2460

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 37D1049908 . This is a "CLIA ID" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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