1568771202 NPI number — SUMMIT HEALTH SOLUTIONS

Table of content: (NPI 1568771202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568771202 NPI number — SUMMIT HEALTH SOLUTIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMMIT HEALTH SOLUTIONS
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:
Provider Other Organization Name Type Code:
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:
1568771202
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20455 248TH CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUTCHINSON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55350-4164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-750-4018
Provider Business Mailing Address Fax Number:
320-587-9060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 3RD AVE SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW LONDON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56273-8647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-905-3256
Provider Business Practice Location Address Fax Number:
320-587-9060
Provider Enumeration Date:
09/29/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WURDELL
Authorized Official First Name:
GUS
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
612-750-4018

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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