Provider Demographics
NPI:1710366315
Name:SUMMIT PHYSICIAN SERVICES
Entity Type:Organization
Organization Name:SUMMIT PHYSICIAN SERVICES
Other - Org Name:WELLSPAN PHYSIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP OF PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LISSA
Authorized Official - Middle Name:N
Authorized Official - Last Name:HINCKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-709-4764
Mailing Address - Street 1:785 5TH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4218
Practice Address - Street 1:12 ST PAUL DR STE 208
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1033
Practice Address - Country:US
Practice Address - Phone:717-217-6072
Practice Address - Fax:717-217-6073
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT PHYSICIAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-28
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007307260079Medicaid