Provider Demographics
NPI:1033684113
Name:SUMMIT HEART AND VASCULAR PLLC
Entity Type:Organization
Organization Name:SUMMIT HEART AND VASCULAR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OBIORA
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:ANUSIONWU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-480-7396
Mailing Address - Street 1:3330 CUMBERLAND BLVD SE STE 200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5996
Mailing Address - Country:US
Mailing Address - Phone:770-951-8427
Mailing Address - Fax:770-951-2157
Practice Address - Street 1:6138 PRECINCT LINE RD STE 100
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2610
Practice Address - Country:US
Practice Address - Phone:972-939-5639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
06933626OtherECFMG
NC1477746840Medicaid