Provider Demographics
NPI:1851485031
Name:SUMMIT ORTHOPAEDICS MANAGEMENT AND CONSULTING, LLC
Entity Type:Organization
Organization Name:SUMMIT ORTHOPAEDICS MANAGEMENT AND CONSULTING, LLC
Other - Org Name:SUMMIT ORTHOPAEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-227-1110
Mailing Address - Street 1:2321 CORONADO ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7407
Mailing Address - Country:US
Mailing Address - Phone:208-227-1100
Mailing Address - Fax:208-227-1087
Practice Address - Street 1:2321 CORONADO ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7407
Practice Address - Country:US
Practice Address - Phone:208-227-1100
Practice Address - Fax:208-227-1087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806422900Medicaid
ID1378273Medicare PIN