1912086125 NPI number — SUMMIT MEDICAL GROUP, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912086125 NPI number — SUMMIT MEDICAL GROUP, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMMIT MEDICAL GROUP, PLLC
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:
SUMMIT MEDICAL GROUP OF KARNS
Provider Other Organization Name Type Code:
3
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:
1912086125
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
08/25/2008
NPI Reactivation Date:
10/19/2010

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1225 E WEISGARBER RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37909-2604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-584-4747
Provider Business Mailing Address Fax Number:
865-584-1363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7715 OAK RIDGE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37931-3338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-694-0376
Provider Business Practice Location Address Fax Number:
865-694-0087
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CURTIS
Authorized Official First Name:
ED
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF ADMINISTRATIVE OFFICER
Authorized Official Telephone Number:
865-584-4747

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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