Provider Demographics
NPI:1073584587
Name:SUMMIT RADIOLOGY PC
Entity Type:Organization
Organization Name:SUMMIT RADIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-432-1568
Mailing Address - Street 1:7221 ENGLE RD STE 220
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-2233
Mailing Address - Country:US
Mailing Address - Phone:260-432-1568
Mailing Address - Fax:260-432-4969
Practice Address - Street 1:7221 ENGLE RD STE 220
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-2233
Practice Address - Country:US
Practice Address - Phone:260-432-1568
Practice Address - Fax:260-432-4969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100282650Medicaid
INCC0677OtherMEDICARE RAILROAD
OH0246246Medicaid
CACA162526Medicare PIN
IN981270Medicare PIN
NVHC240AMedicare PIN
CACR507BMedicare PIN
MIMI1209Medicare PIN
INCC0677OtherMEDICARE RAILROAD
OH0246246Medicaid
HICO759AMedicare PIN
OHH181750Medicare PIN
NJ444340Medicare PIN
INCC0677Medicare PIN