Provider Demographics
NPI:1093284408
Name:SUMMIT HEALTHCARE IPA CORP.
Entity Type:Organization
Organization Name:SUMMIT HEALTHCARE IPA CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:N
Authorized Official - Last Name:SAMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-850-5630
Mailing Address - Street 1:6119 E WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-2436
Mailing Address - Country:US
Mailing Address - Phone:888-350-6599
Mailing Address - Fax:888-444-9401
Practice Address - Street 1:23049 ARCHIBALD AVE
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-4718
Practice Address - Country:US
Practice Address - Phone:310-850-5630
Practice Address - Fax:888-444-9401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty