Provider Demographics
NPI:1326549031
Name:SUMMIT HEALTHCARE ASSOCIATION
Entity Type:Organization
Organization Name:SUMMIT HEALTHCARE ASSOCIATION
Other - Org Name:SUMMIT HEALTHCARE AT BISON RANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-537-6389
Mailing Address - Street 1:2352 QUARTER HORSE TRAIL
Mailing Address - Street 2:
Mailing Address - City:OVERGAARD
Mailing Address - State:AZ
Mailing Address - Zip Code:85933
Mailing Address - Country:US
Mailing Address - Phone:928-537-6910
Mailing Address - Fax:952-653-2540
Practice Address - Street 1:2352 QUARTER HORSE TRAIL
Practice Address - Street 2:
Practice Address - City:OVERGAARD
Practice Address - State:AZ
Practice Address - Zip Code:85933
Practice Address - Country:US
Practice Address - Phone:928-537-6910
Practice Address - Fax:952-653-2540
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT HEALTHCARE ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC8162332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site