Provider Demographics
NPI:1609188689
Name:SUMMIT HEALTH LLC
Entity Type:Organization
Organization Name:SUMMIT HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SIDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-229-0085
Mailing Address - Street 1:3150 CUSTER DR
Mailing Address - Street 2:201
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4010
Mailing Address - Country:US
Mailing Address - Phone:859-229-0085
Mailing Address - Fax:
Practice Address - Street 1:3150 CUSTER DR
Practice Address - Street 2:201
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4010
Practice Address - Country:US
Practice Address - Phone:859-229-0085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)