Provider Demographics
NPI:1558001479
Name:SUMMIT URGENT CARE AT DILLON, LLC
Entity Type:Organization
Organization Name:SUMMIT URGENT CARE AT DILLON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASSI
Authorized Official - Middle Name:
Authorized Official - Last Name:NIZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-640-1632
Mailing Address - Street 1:PO BOX 6132
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63006-6132
Mailing Address - Country:US
Mailing Address - Phone:314-640-1632
Mailing Address - Fax:
Practice Address - Street 1:956 W. ANEMONE TRAIL
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:CO
Practice Address - Zip Code:80435
Practice Address - Country:US
Practice Address - Phone:314-640-1632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service