Provider Demographics
NPI:1013555119
Name:SUMMIT PHYSICIAN SERVICES
Entity Type:Organization
Organization Name:SUMMIT PHYSICIAN SERVICES
Other - Org Name:WELLSPAN NEPHROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP OF PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LISSA
Authorized Official - Middle Name:N
Authorized Official - Last Name:HINCKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-709-4764
Mailing Address - Street 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-709-6529
Practice Address - Street 1:765 5TH AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4228
Practice Address - Country:US
Practice Address - Phone:717-263-8811
Practice Address - Fax:717-245-9652
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT PHYSICIAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-19
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty