1750035440 NPI number — SUMMIT COMMUNITY CARE CLINIC, INC.

Table of content: MISS KAREN LOUISE ROBINSON (NPI 1942331913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750035440 NPI number — SUMMIT COMMUNITY CARE CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMMIT COMMUNITY CARE CLINIC, INC.
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:
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 Information

NPI Number:
1750035440
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1620 W. NORTHWEST HWY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
GRAPEVINE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-572-0009
Provider Business Mailing Address Fax Number:
817-572-0221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
360 PEAK ONE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 100A
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80443-5948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-486-3110
Provider Business Practice Location Address Fax Number:
970-486-8476
Provider Enumeration Date:
02/10/2022

Additional Information

Authorized Official

Authorized Official Last Name:
COGDILL
Authorized Official First Name:
JOSH
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
970-668-6889

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 343134 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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