Provider Demographics
NPI:1174689988
Name:SUMMIT SPORTS & FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:SUMMIT SPORTS & FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-561-6300
Mailing Address - Street 1:PO BOX 83270
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85071-3270
Mailing Address - Country:US
Mailing Address - Phone:602-942-6166
Mailing Address - Fax:602-942-6188
Practice Address - Street 1:7717 W DEER VALLEY RD
Practice Address - Street 2:SUITE 125
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2102
Practice Address - Country:US
Practice Address - Phone:623-561-6300
Practice Address - Fax:623-572-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ104588Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER