Provider Demographics
NPI:1346986445
Name:SUMMIT MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:SUMMIT MEDICAL CENTER, LLC
Other - Org Name:SUMMIT MEDICAL CENTER PHYSICIANS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:VUCETIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-232-6600
Mailing Address - Street 1:6350 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4264
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6350 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4264
Practice Address - Country:US
Practice Address - Phone:307-232-3235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty