Provider Demographics
NPI:1659807261
Name:SUMMIT HEALTHCARE MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:SUMMIT HEALTHCARE MEDICAL ASSOCIATES
Other - Org Name:SUMMIT HEALTHCARE ASSOCIATION
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER-PAIN CLINIC
Authorized Official - Prefix:
Authorized Official - First Name:CHANCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-532-1605
Mailing Address - Street 1:1500 S WHITE MOUNTAIN RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7111
Mailing Address - Country:US
Mailing Address - Phone:928-532-1605
Mailing Address - Fax:928-532-9581
Practice Address - Street 1:1500 S WHITE MOUNTAIN RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7111
Practice Address - Country:US
Practice Address - Phone:928-532-1605
Practice Address - Fax:928-532-9581
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT HEALTHCARE ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty