Provider Demographics
NPI:1285181404
Name:SUMMIT FAMILY HEALTH
Entity Type:Organization
Organization Name:SUMMIT FAMILY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-893-9184
Mailing Address - Street 1:1828 S MILLENIUM WAY
Mailing Address - Street 2:STE 300
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5036
Mailing Address - Country:US
Mailing Address - Phone:208-893-9184
Mailing Address - Fax:
Practice Address - Street 1:1828 S MILLENIUM WAY
Practice Address - Street 2:STE 300
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5036
Practice Address - Country:US
Practice Address - Phone:208-893-9184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20000379Medicare PIN