Basic Information
| Provider Information | |||||||||
| NPI: | 1225084502 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUMMIT COUNTY INTERNISTS & ASSOCIATES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26010 | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443196010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304930840 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2040 E MARKET ST | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443121100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307842224 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 01/14/2008 | ||||||||
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| AuthorizedOfficialLastName: | EPLING | ||||||||
| AuthorizedOfficialFirstName: | GAYLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3303753419 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | CI4532 | 01 | OH | RAILROAD MEDICARE | OTHER | 0107217 | 05 | OH | MEDICAID | CA6828 | 01 | OH | RAILROAD MEDICARE | OTHER | CA6322 | 01 | OH | RAILROAD MEDICARE | OTHER | DB1931 | 01 | OH | RAILROAD MEDICARE | OTHER |