Provider Demographics
NPI:1841739257
Name:SUMMIT NEUROENDOVASCULAR SPECIALISTS, LLC
Entity Type:Organization
Organization Name:SUMMIT NEUROENDOVASCULAR SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FIRAS
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-344-2387
Mailing Address - Street 1:3867 MEDINA RD # 270
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4525
Mailing Address - Country:US
Mailing Address - Phone:330-344-2387
Mailing Address - Fax:330-344-6344
Practice Address - Street 1:3867 MEDINA RD # 270
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-4525
Practice Address - Country:US
Practice Address - Phone:330-344-2387
Practice Address - Fax:330-344-6344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0221080Medicaid