1073526208 NPI number — SUMMIT SURGICAL CENTER, LLC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073526208 NPI number — SUMMIT SURGICAL CENTER, LLC

Employer Identification Number (EIN):

Provider Organization Name:

SUMMIT SURGICAL CENTER, LLC

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

Provider Other Organization Name Type Code:

6

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:

1073526208

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

03/26/2025

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

200 BOWMAN DRIVE

Provider Second Line Business Mailing Address:

SUITE D160

Provider Business Mailing Address City Name:

VOORHEES

Provider Business Mailing Address State Name:

NJ

Provider Business Mailing Address Postal Code:

08043

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

856-247-7838

Provider Business Mailing Address Fax Number:

856-247-7858

Provider First Line Business Practice Location Address:

5000 SAGEMORE DRIVE

Provider Second Line Business Practice Location Address:

SUITE 106

Provider Business Practice Location Address City Name:

MARLTON

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

08053

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

856-983-4263

Provider Business Practice Location Address Fax Number:

856-983-9362

Provider Enumeration Date:

08/15/2006

Authorized Official Last Name:

FENDRICK

Authorized Official First Name:

STEPHANIE

Authorized Official Middle Name:

Authorized Official Title or Position:

CO-CHAIR

Authorized Official Telephone Number:

856-247-7838

• Taxonomy code: 261QA1903X , with the licence number:  24019 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0001480000 . This is a "KEYSTONE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 311051 . This is a "HORIZON BCBS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 000K06569 . This is a "1ST OPTION/PHS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 7287328 . This is a "AETNA PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 0001480000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: ANC844 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 2683282 . This is a "AETNA HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 490002554 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 0001480000 . This is a "HIGHMARK" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 1372571009M . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: IL2400 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".