Basic Information
| Provider Information | |||||||||
| NPI: | 1831219328 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUMMIT COMMUNITY CARE CLINIC, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4337 | ||||||||
| Address2: | 360 PEAK ONE DRIVE, SUITE 100 | ||||||||
| City: | FRISCO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804434337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706684040 | ||||||||
| FaxNumber: | 9706684040 | ||||||||
| Practice Location | |||||||||
| Address1: | 360 PEAK ONE DRIVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FRISCO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706684040 | ||||||||
| FaxNumber: | 9706686699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| 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 | 261QF0050X | N | Ambulatory Health Care Facilities | Clinic/Center | Family Planning, Non-Surgical | 261QF0400X | N | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.