Basic Information
| Provider Information | |||||||||
| NPI: | 1750873667 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUMMIT ORTHOPEDICS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 660 GOLDEN RIDGE RD STE 250 | ||||||||
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| City: | GOLDEN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804019541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037247321 | ||||||||
| FaxNumber: | 7204976741 | ||||||||
| Practice Location | |||||||||
| Address1: | 68 SCHOOL ROAD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FRISCO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702627400 | ||||||||
| FaxNumber: | 9702627401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2018 | ||||||||
| LastUpdateDate: | 07/15/2020 | ||||||||
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| AuthorizedOfficialLastName: | CONKLIN | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3032747321 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PANORAMA ORTHOPEDICS AND SPINE CENTER PC | ||||||||
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| NPICertificationDate: | 07/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207X00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.