Basic Information
| Provider Information | |||||||||
| NPI: | 1528328911 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SUMMA PHYSICIAN INC | ||||||||
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| OtherOrganizationName: | SUMMA HEALTH MEDICAL GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1077 GORGE BLVD | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443102408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2343125873 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2875 W MARKET ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FAIRLAWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443334064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308355533 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2012 | ||||||||
| LastUpdateDate: | 07/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | ROOD | ||||||||
| AuthorizedOfficialFirstName: | GINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR IT SYSTEMS ANALYST | ||||||||
| AuthorizedOfficialTelephone: | 2343125193 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207XS0117X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 363LF0000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 207QS0010X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0065369 | 05 | OH | MEDICAID |