Provider Demographics
NPI:1477104552
Name:SUMMIT HEALTHCARE ASSOCIATION
Entity Type:Organization
Organization Name:SUMMIT HEALTHCARE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH PLAN CREDENTIALING COORDINAT
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-537-6393
Mailing Address - Street 1:2200 E SHOW LOW LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7831
Mailing Address - Country:US
Mailing Address - Phone:928-537-6393
Mailing Address - Fax:928-532-2131
Practice Address - Street 1:2200 E SHOW LOW LAKE RD
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7831
Practice Address - Country:US
Practice Address - Phone:928-537-6393
Practice Address - Fax:928-532-2131
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT HEALTHCARE ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit