1104406800 NPI number — SUMMA HEALTH OUTPATIENT SERVICES LLC

Table of content: LAURA LOMAX MS, RD,LD (NPI 1437531712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104406800 NPI number — SUMMA HEALTH OUTPATIENT SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMMA HEALTH OUTPATIENT SERVICES 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'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:
1104406800
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 E MARKET ST
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:
44304-1619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
234-312-5656
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3825 FISHCREEK RD STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STOW
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44224-4316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
234-867-6964
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2021

Additional Information

Authorized Official

Authorized Official Last Name:
INGMIRE
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
234-312-5656

Provider Taxonomy Codes

  • Taxonomy code: 261QI0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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