Basic Information
| Provider Information | |||||||||
| NPI: | 1821414293 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUMMIT COMMUNITY CARE CLINIC, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4337 | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804434337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706684040 | ||||||||
| FaxNumber: | 9706686699 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 HAMILTON CREEK ROAD | ||||||||
| Address2: | |||||||||
| City: | SILVERTHORNE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706684040 | ||||||||
| FaxNumber: | 9706686699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2014 | ||||||||
| LastUpdateDate: | 03/01/2018 | ||||||||
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| AuthorizedOfficialLastName: | ROYAL | ||||||||
| AuthorizedOfficialFirstName: | HELEN | ||||||||
| AuthorizedOfficialMiddleName: | Q | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9706684040 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | 18L200 | CO | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
No ID Information.