Provider Demographics
NPI:1336637263
Name:SUMMIT MEDICAL PAIN & SPINE
Entity Type:Organization
Organization Name:SUMMIT MEDICAL PAIN & SPINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAMMELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-851-1671
Mailing Address - Street 1:4465 S. 900 E.
Mailing Address - Street 2:STE. 275
Mailing Address - City:MILLCREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84124-2644
Mailing Address - Country:US
Mailing Address - Phone:801-266-2440
Mailing Address - Fax:
Practice Address - Street 1:4465 S 900 E STE 275
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84124-2644
Practice Address - Country:US
Practice Address - Phone:208-851-1671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-26
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty