Provider Demographics
NPI: | 1003061243 |
---|---|
Name: | SUMMA PHYSICIANS INC |
Entity Type: | Organization |
Organization Name: | SUMMA PHYSICIANS INC |
Other - Org Name: | SUMMA HEALTH MEDICAL GROUP |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LYDIA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ALEXANDER-COOK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 234-312-5873 |
Mailing Address - Street 1: | 1077 GORGE BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | AKRON |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 44310-2408 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 234-312-5873 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3780 MEDINA RD STE 220 |
Practice Address - Street 2: | |
Practice Address - City: | MEDINA |
Practice Address - State: | OH |
Practice Address - Zip Code: | 44256-9312 |
Practice Address - Country: | US |
Practice Address - Phone: | 330-434-0543 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-12-01 |
Last Update Date: | 2020-03-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 207QS0010X | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | Group - Multi-Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 207RS0012X | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | Group - Multi-Specialty |
No | 207VF0040X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Female Pelvic Medicine and Reconstructive Surgery | Group - Multi-Specialty |
No | 207VX0201X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology | Group - Multi-Specialty |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207XS0117X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | Group - Multi-Specialty |
No | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | Group - Multi-Specialty |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
No | 364S00000X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
9284141 | Medicare PIN | ||
9284141 | Medicare PIN |