Provider Demographics
NPI:1437407376
Name:SUMMIT ORTHOPEDICS
Entity Type:Organization
Organization Name:SUMMIT ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:D
Authorized Official - Last Name:SURFACE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-414-2120
Mailing Address - Street 1:401 DIVISION ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1455
Mailing Address - Country:US
Mailing Address - Phone:304-414-2120
Mailing Address - Fax:304-414-2129
Practice Address - Street 1:401 DIVISION ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1455
Practice Address - Country:US
Practice Address - Phone:304-414-2120
Practice Address - Fax:304-414-2129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV1585174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty