Provider Demographics
NPI:1700032307
Name:SUMMIT MEDICAL LLC
Entity Type:Organization
Organization Name:SUMMIT MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANCELLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-474-9302
Mailing Address - Street 1:3755 APPLEWOOD CREEK
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:64203
Mailing Address - Country:US
Mailing Address - Phone:573-474-9302
Mailing Address - Fax:
Practice Address - Street 1:505 ARBOR DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6552
Practice Address - Country:US
Practice Address - Phone:573-474-9302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies