Provider Demographics
NPI:1194193318
Name:SUMMIT AUTO & CYCLE
Entity Type:Organization
Organization Name:SUMMIT AUTO & CYCLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IZAAK
Authorized Official - Middle Name:
Authorized Official - Last Name:DECOOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-696-5217
Mailing Address - Street 1:18956 480TH ST
Mailing Address - Street 2:
Mailing Address - City:ZUMBROTA
Mailing Address - State:MN
Mailing Address - Zip Code:55992-7283
Mailing Address - Country:US
Mailing Address - Phone:507-696-5217
Mailing Address - Fax:
Practice Address - Street 1:18956 480TH ST
Practice Address - Street 2:
Practice Address - City:ZUMBROTA
Practice Address - State:MN
Practice Address - Zip Code:55992-7283
Practice Address - Country:US
Practice Address - Phone:507-696-5217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies