Provider Demographics
NPI:1265043889
Name:SUMMIT MATERNITY CARE CENTER
Entity Type:Organization
Organization Name:SUMMIT MATERNITY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:941-264-6084
Mailing Address - Street 1:950 TAMIAMI TRL UNIT 101
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33953-3102
Mailing Address - Country:US
Mailing Address - Phone:941-264-6084
Mailing Address - Fax:570-227-2306
Practice Address - Street 1:950 TAMIAMI TRL UNIT 101
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33953-3102
Practice Address - Country:US
Practice Address - Phone:941-264-6084
Practice Address - Fax:570-227-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center