Provider Demographics
NPI:1073526208
Name:SUMMIT SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:SUMMIT SURGICAL CENTER, LLC
Other - Org Name:HAND SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-247-7838
Mailing Address - Street 1:200 BOWMAN DRIVE
Mailing Address - Street 2:SUITE D160
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043
Mailing Address - Country:US
Mailing Address - Phone:856-247-7838
Mailing Address - Fax:856-247-7858
Practice Address - Street 1:5000 SAGEMORE DRIVE
Practice Address - Street 2:SUITE 106
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-983-4263
Practice Address - Fax:856-983-9362
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT SURGICAL CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-15
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ24019261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0001480000OtherKEYSTONE
NJ311051OtherHORIZON BCBS
NJ000K06569Other1ST OPTION/PHS
NJ7287328OtherAETNA PPO
NJ0001480000OtherAMERIHEALTH
NJANC844OtherOXFORD
NJ2683282OtherAETNA HMO
NJ490002554OtherMEDICARE RAILROAD
NJ0001480000OtherHIGHMARK
NJ1372571009MOtherCIGNA
NJIL2400OtherHEALTHNET
NJ1372571009MOtherCIGNA