Provider Demographics
NPI:1679744643
Name:SUMMIT MEDICAL CENTER S.C.
Entity Type:Organization
Organization Name:SUMMIT MEDICAL CENTER S.C.
Other - Org Name:SUMMIT MEDICAL CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANKIT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-496-9549
Mailing Address - Street 1:6252 S ARCHER RD
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:IL
Mailing Address - Zip Code:60501-1720
Mailing Address - Country:US
Mailing Address - Phone:708-496-9549
Mailing Address - Fax:708-728-9429
Practice Address - Street 1:6252 S ARCHER RD
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:IL
Practice Address - Zip Code:60501-1720
Practice Address - Country:US
Practice Address - Phone:708-496-9549
Practice Address - Fax:708-728-9429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086195261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086195Medicaid
IL036086195Medicaid