Basic Information
| Provider Information | |||||||||
| NPI: | 1396398624 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUMMIT MEDICAL GROUP, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1360 DOLWICK DRIVE | ||||||||
| Address2: | |||||||||
| City: | ERLANGER | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593445555 | ||||||||
| FaxNumber: | 8593445552 | ||||||||
| Practice Location | |||||||||
| Address1: | 79 COUNTRY CLUB DRIVE | ||||||||
| Address2: | |||||||||
| City: | BUTLER | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410068704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8596542283 | ||||||||
| FaxNumber: | 8596542284 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2019 | ||||||||
| LastUpdateDate: | 07/16/2019 | ||||||||
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| AuthorizedOfficialLastName: | RANKIN | ||||||||
| AuthorizedOfficialFirstName: | MARIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | AVP- REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 8596552583 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SUMMIT MEDICAL GROUP, INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 363L00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207R00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.