Provider Demographics
NPI:1821450008
Name:SUMMIT COMMUNITY CARE CLINIC, INC.
Entity Type:Organization
Organization Name:SUMMIT COMMUNITY CARE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-668-4040
Mailing Address - Street 1:PO BOX 4337
Mailing Address - Street 2:360 PEAK ONE DRIVE SUITE 100
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-4337
Mailing Address - Country:US
Mailing Address - Phone:970-668-4040
Mailing Address - Fax:970-668-6699
Practice Address - Street 1:223 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:LEADVILLE
Practice Address - State:CO
Practice Address - Zip Code:80461-3392
Practice Address - Country:US
Practice Address - Phone:970-668-4040
Practice Address - Fax:970-668-6699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty