Provider Demographics
NPI:1811401284
Name:SUMMIT RADIOLOGY, LLC
Entity Type:Organization
Organization Name:SUMMIT RADIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:URBAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-654-2486
Mailing Address - Street 1:3849 N. PERRYVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114
Mailing Address - Country:US
Mailing Address - Phone:815-654-2486
Mailing Address - Fax:815-654-2680
Practice Address - Street 1:3849 N. PERRYVILLE ROAD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114
Practice Address - Country:US
Practice Address - Phone:815-654-2486
Practice Address - Fax:815-654-2680
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT RADIOLOGY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty