1750343216 NPI number — SUMMIT MEDICAL GROUP, INC

Table of content: (NPI 1750343216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750343216 NPI number — SUMMIT MEDICAL GROUP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMMIT MEDICAL GROUP, 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:
1750343216
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1360 DOLWICK DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERLANGER
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41018-3127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-344-5555
Provider Business Mailing Address Fax Number:
859-344-5552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1360 DOLWICK DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ERLANGER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41018-3127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-344-5555
Provider Business Practice Location Address Fax Number:
859-344-5552
Provider Enumeration Date:
04/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RANKIN
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
Authorized Official Title or Position:
AVP-REVENUE CYCLE
Authorized Official Telephone Number:
859-344-5555

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2355115 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2501152300 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200993310 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201157570 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100235410 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 78003852 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: CC3684 . This is a "RAILROAD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 201152300 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100018930 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: DQ9133 . This is a "RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 65926743 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100235400 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100271890 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100311260 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: DR8623 . This is a "RAILROAD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 78902020 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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