Provider Demographics
NPI:1205015559
Name:SUMMIT COUNTY INTERNISTS
Entity Type:Organization
Organization Name:SUMMIT COUNTY INTERNISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:EPLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-375-3419
Mailing Address - Street 1:55 ARCH ST
Mailing Address - Street 2:STE 1A
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1423
Mailing Address - Country:US
Mailing Address - Phone:330-375-3419
Mailing Address - Fax:330-375-3760
Practice Address - Street 1:600 PORTAGE TRAIL WEST
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-2544
Practice Address - Country:US
Practice Address - Phone:330-928-4427
Practice Address - Fax:330-928-9957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0538270Medicaid
OH0538270Medicaid
OHA15550Medicare UPIN