Provider Demographics
NPI:1245746635
Name:SUMMIT INTERNAL MEDICINE, INC.
Entity Type:Organization
Organization Name:SUMMIT INTERNAL MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-979-7790
Mailing Address - Street 1:6179 S BALSAM WAY STE 210
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-3093
Mailing Address - Country:US
Mailing Address - Phone:303-347-2000
Mailing Address - Fax:303-974-2197
Practice Address - Street 1:6179 S BALSAM WAY STE 210
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3093
Practice Address - Country:US
Practice Address - Phone:303-347-2000
Practice Address - Fax:720-974-2197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO23775556Medicaid