Basic Information
| Provider Information | |||||||||
| NPI: | 1588837488 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUMMA PHYSICIANS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 E MARKET ST | ||||||||
| Address2: | P.O. BOX 2090 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443041619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309968603 | ||||||||
| FaxNumber: | 3309960359 | ||||||||
| Practice Location | |||||||||
| Address1: | 2875 W MARKET ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FAIRLAWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443334064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308644488 | ||||||||
| FaxNumber: | 3308643739 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2008 | ||||||||
| LastUpdateDate: | 02/13/2013 | ||||||||
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| AuthorizedOfficialLastName: | FREDERICKS | ||||||||
| AuthorizedOfficialFirstName: | BRYAN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3309968603 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2816233 | 05 | OH | MEDICAID |