Basic Information
| Provider Information | |||||||||
| NPI: | 1700054061 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUMMIT SURGICAL ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 ARCH ST STE 404B | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443041433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303767207 | ||||||||
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| Practice Location | |||||||||
| Address1: | 75 ARCH ST STE 404B | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443041433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303767207 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2008 | ||||||||
| LastUpdateDate: | 04/01/2008 | ||||||||
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| AuthorizedOfficialLastName: | SAYRE | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3303767207 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 45457 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0980854 | 05 | OH | MEDICAID |