Basic Information
| Provider Information | |||||||||
| NPI: | 1962477943 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE SUMMIT HEALTH & REHAB SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4109 HWY 98 W | ||||||||
| Address2: | PO BOX 579 | ||||||||
| City: | SUMMIT | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888990325 | ||||||||
| FaxNumber: | 6012763900 | ||||||||
| Practice Location | |||||||||
| Address1: | 4109 HWY 98 W | ||||||||
| Address2: | |||||||||
| City: | SUMMIT | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888990325 | ||||||||
| FaxNumber: | 6012763900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2006 | ||||||||
| LastUpdateDate: | 04/01/2016 | ||||||||
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| AuthorizedOfficialLastName: | BATES | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER CEO | ||||||||
| AuthorizedOfficialTelephone: | 8888990325 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | MS | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
ID Information
| ID | Type | State | Issuer | Description | 03583531 | 05 | MS | MEDICAID |