Basic Information
| Provider Information | |||||||||
| NPI: | 1740370501 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUMMIT SURGERY AND RECOVERY CARE CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1485 N TURQUOISE DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860011398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287747757 | ||||||||
| FaxNumber: | 9287747767 | ||||||||
| Practice Location | |||||||||
| Address1: | 1485 N TURQUOISE DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860011397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287747757 | ||||||||
| FaxNumber: | 9287747767 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 04/03/2012 | ||||||||
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| AuthorizedOfficialLastName: | POTTS | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9287747757 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | OSC0056 | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.