Provider Demographics
NPI:1417241811
Name:SUMMIT HEALTHCARE INC
Entity Type:Organization
Organization Name:SUMMIT HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:N
Authorized Official - Last Name:SAMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR OF MEDICINE
Authorized Official - Phone:213-351-9100
Mailing Address - Street 1:3621 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-3512
Mailing Address - Country:US
Mailing Address - Phone:310-850-5630
Mailing Address - Fax:310-765-6375
Practice Address - Street 1:23049 ARCHIBALD AVE
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-4718
Practice Address - Country:US
Practice Address - Phone:310-850-5630
Practice Address - Fax:310-765-6375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98537174400000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty