Provider Demographics
NPI: | 1508287640 |
---|---|
Name: | SUMMIT MEDICAL GROUP, INC |
Entity Type: | Organization |
Organization Name: | SUMMIT MEDICAL GROUP, INC |
Other - Org Name: | ST. ELIZABETH PHYSICIANS BEHAVIORAL HEALTH |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | AVP- REVENUE CYCLE |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MARIA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | RANKIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 859-344-5555 |
Mailing Address - Street 1: | 1360 DOLWICK DRIVE |
Mailing Address - Street 2: | |
Mailing Address - City: | ERLANGER |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 41018-3127 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 859-344-5555 |
Mailing Address - Fax: | 859-344-5552 |
Practice Address - Street 1: | 1360 DOLWICK DRIVE |
Practice Address - Street 2: | |
Practice Address - City: | ERLANGER |
Practice Address - State: | KY |
Practice Address - Zip Code: | 41018-3127 |
Practice Address - Country: | US |
Practice Address - Phone: | 859-344-5555 |
Practice Address - Fax: | 859-344-5552 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-12-16 |
Last Update Date: | 2020-07-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207QA0401X | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | Group - Multi-Specialty |
No | 207QH0002X | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine | Group - Multi-Specialty |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
No | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | Group - Multi-Specialty |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |