Provider Demographics
NPI:1487676433
Name:SUMMIT CANCER CARE, P.C.
Entity Type:Organization
Organization Name:SUMMIT CANCER CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-354-6187
Mailing Address - Street 1:5400 SUTLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4721
Mailing Address - Country:US
Mailing Address - Phone:912-354-6187
Mailing Address - Fax:912-355-9807
Practice Address - Street 1:4700 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-354-6187
Practice Address - Fax:912-355-9807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300022032HMedicaid
SCCJ9781Medicare ID - Type UnspecifiedSC RR MEDICARE GROUP
GA300022032HMedicaid
GAGRP359Medicare PIN
GACA9634Medicare ID - Type UnspecifiedGA RR MEDICARE GROUP