Provider Demographics
NPI:1174011571
Name:SUMMIT HEALTH FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:SUMMIT HEALTH FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:BENSON-VALDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-618-0031
Mailing Address - Street 1:507 BERRY JAMES CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-8514
Mailing Address - Country:US
Mailing Address - Phone:407-618-0031
Mailing Address - Fax:435-250-3507
Practice Address - Street 1:507 BERRY JAMES CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-8514
Practice Address - Country:US
Practice Address - Phone:407-618-0031
Practice Address - Fax:435-250-3507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty