Provider Demographics
NPI:1437271681
Name:SUMMER RIVER INC COMPLETE MEDICAL
Entity Type:Organization
Organization Name:SUMMER RIVER INC COMPLETE MEDICAL
Other - Org Name:COMPLETE MEDICAL PRODUCTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:FLANAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-363-3460
Mailing Address - Street 1:20419 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11697-1120
Mailing Address - Country:US
Mailing Address - Phone:718-945-9119
Mailing Address - Fax:718-945-6034
Practice Address - Street 1:90-09 ROCKAWAY BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:NY
Practice Address - Zip Code:11693-1531
Practice Address - Country:US
Practice Address - Phone:718-945-9119
Practice Address - Fax:718-945-6034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
206175300OtherDOL
1227420001Medicare ID - Type Unspecified