Provider Demographics
NPI:1710691647
Name:CENTURA SUMMIT ORTHOPEDICS LLC
Entity Type:Organization
Organization Name:CENTURA SUMMIT ORTHOPEDICS LLC
Other - Org Name:CENTURA SUMMIT ORTHOPEDICS (DME)
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR, OMA
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-667-7283
Mailing Address - Street 1:PO BOX 650823
Mailing Address - Street 2:DEPT 42409
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0823
Mailing Address - Country:US
Mailing Address - Phone:970-262-7400
Mailing Address - Fax:920-262-7401
Practice Address - Street 1:68 SCHOOL RD
Practice Address - Street 2:STE 100
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-262-7400
Practice Address - Fax:970-262-7401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies