Provider Demographics
NPI:1821190133
Name:WILLIAM D.SUMMERS MD, GYNECOLOGY LLC
Entity Type:Organization
Organization Name:WILLIAM D.SUMMERS MD, GYNECOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-838-3740
Mailing Address - Street 1:52 MEDICAL PARK EAST DRIVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3430
Mailing Address - Country:US
Mailing Address - Phone:205-838-3740
Mailing Address - Fax:205-838-3845
Practice Address - Street 1:52 MEDICAL PARK EAST DRIVE
Practice Address - Street 2:SUITE 215
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3430
Practice Address - Country:US
Practice Address - Phone:205-838-3740
Practice Address - Fax:205-838-3845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00014623174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1821190133OtherNPI
AL529925880OtherGROUP PAYOR MEDICAID OF ALABAMA
AL051530187Medicaid
AL=========OtherTAX ID
AL51530187Medicare PIN
AL1821190133OtherNPI