Provider Demographics
NPI:1346515491
Name:SUMMIT MEDICAL GROUP
Entity Type:Organization
Organization Name:SUMMIT MEDICAL GROUP
Other - Org Name:ST. ELIZABETH PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDEN, CEO
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOOMIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-344-3733
Mailing Address - Street 1:2300 CHAMBER CENTER DR
Mailing Address - Street 2:SU. 200
Mailing Address - City:LAKESIDE PARK
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1673
Mailing Address - Country:US
Mailing Address - Phone:859-344-5555
Mailing Address - Fax:859-344-5552
Practice Address - Street 1:204 BRIDGEWAY ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IN
Practice Address - Zip Code:47001-1334
Practice Address - Country:US
Practice Address - Phone:812-926-3133
Practice Address - Fax:812-926-1668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty