Provider Demographics
NPI:1528020609
Name:SUMMIT ENT MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:SUMMIT ENT MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:W
Authorized Official - Last Name:MOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-465-0941
Mailing Address - Street 1:2961 SUMMIT ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3482
Mailing Address - Country:US
Mailing Address - Phone:510-465-0941
Mailing Address - Fax:510-465-0941
Practice Address - Street 1:2961 SUMMIT ST
Practice Address - Street 2:SUITE 1
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3482
Practice Address - Country:US
Practice Address - Phone:510-465-0941
Practice Address - Fax:510-465-0941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ49994ZOtherBLUE SHIELD
CAGR0067410Medicaid
CAZZZ49994ZOtherBLUE SHIELD
CAGR0067410Medicaid