Basic Information
| Provider Information | |||||||||
| NPI: | 1689870495 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUMMA PHYSICIANS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1077 GORGE BLVD | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443102408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2343125541 | ||||||||
| FaxNumber: | 3309968695 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 BOETTLER RD | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | UNIONTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446857792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308990693 | ||||||||
| FaxNumber: | 3308991502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2007 | ||||||||
| LastUpdateDate: | 10/24/2014 | ||||||||
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| AuthorizedOfficialLastName: | HAJSKI | ||||||||
| AuthorizedOfficialFirstName: | LYNNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 2343125541 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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 |
ID Information
| ID | Type | State | Issuer | Description | 2781815 | 05 | OH | MEDICAID |