Provider Demographics
NPI:1083377261
Name:SUMMIT MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:SUMMIT MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:801-867-9760
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-0425
Mailing Address - Country:US
Mailing Address - Phone:801-867-9760
Mailing Address - Fax:801-880-4400
Practice Address - Street 1:2700 W 5600 S
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-1372
Practice Address - Country:US
Practice Address - Phone:801-867-9760
Practice Address - Fax:801-880-4400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty