1285380881 NPI number — SUMMIT HEALTHCARE MEDICAL ASSOCIATES

Table of content: (NPI 1285380881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285380881 NPI number — SUMMIT HEALTHCARE MEDICAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMMIT HEALTHCARE MEDICAL ASSOCIATES
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:
1285380881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 E SHOW LOW LAKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHOW LOW
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85901-7831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-537-6393
Provider Business Mailing Address Fax Number:
928-532-2131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
728 E WHITE MOUNTAIN BLVD #A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINETOP
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-367-6688
Provider Business Practice Location Address Fax Number:
928-367-4916
Provider Enumeration Date:
02/23/2022

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
CHIEF PRACTICE OFFICER
Authorized Official Telephone Number:
928-537-4375

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com