Provider Demographics
NPI:1053865246
Name:SUMMIT MEDICAL WEST LLC
Entity Type:Organization
Organization Name:SUMMIT MEDICAL WEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:6773
Authorized Official - Middle Name:
Authorized Official - Last Name:MANAGEMENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-482-7515
Mailing Address - Street 1:10115 E BELL RD
Mailing Address - Street 2:SUITE 107-436
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2189
Mailing Address - Country:US
Mailing Address - Phone:480-482-7515
Mailing Address - Fax:
Practice Address - Street 1:6929 N HAYDEN RD
Practice Address - Street 2:SUITE C4-220
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-7978
Practice Address - Country:US
Practice Address - Phone:480-482-7515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-05
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies