Provider Demographics
NPI:1477605277
Name:SUMMIT MEDICAL GROUP,PLLC
Entity Type:Organization
Organization Name:SUMMIT MEDICAL GROUP,PLLC
Other - Org Name:SUMMIT PHYSICAL THERAPY SERVICE WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICE
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-584-4747
Mailing Address - Street 1:9333 PARK WEST BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4341
Mailing Address - Country:US
Mailing Address - Phone:865-588-8278
Mailing Address - Fax:865-588-8341
Practice Address - Street 1:9333 PARK WEST BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4341
Practice Address - Country:US
Practice Address - Phone:865-588-8278
Practice Address - Fax:865-588-8341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty