Provider Demographics
NPI:1821085259
Name:MEDICAL GROUP SUMMIT INC
Entity Type:Organization
Organization Name:MEDICAL GROUP SUMMIT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-7600
Mailing Address - Street 1:3901 CENTRAL PIKE
Mailing Address - Street 2:SUITE 352
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3419
Mailing Address - Country:US
Mailing Address - Phone:615-882-4000
Mailing Address - Fax:615-882-4002
Practice Address - Street 1:3901 CENTRAL PIKE
Practice Address - Street 2:SUITE 352
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3419
Practice Address - Country:US
Practice Address - Phone:615-391-5567
Practice Address - Fax:615-391-5530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3707047Medicaid
TN3707047Medicare ID - Type Unspecified