Basic Information
| Provider Information | |||||||||
| NPI: | 1568902864 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUMMIT MEDICAL GROUP INC | ||||||||
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| OtherOrganizationName: | ST ELIZABETH PHYSICIANS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 CHAMBER CENTER DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | FORT MITCHELL | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593445555 | ||||||||
| FaxNumber: | 8593445552 | ||||||||
| Practice Location | |||||||||
| Address1: | 8200 DIXIE HWY | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410423225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592120494 | ||||||||
| FaxNumber: | 8592821545 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2017 | ||||||||
| LastUpdateDate: | 03/06/2017 | ||||||||
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| AuthorizedOfficialLastName: | PRICHARD | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8593443737 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.