Provider Demographics
NPI:1851991004
Name:SUMMERS, EDWARD N JR
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:N
Last Name:SUMMERS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20068
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43610-0068
Mailing Address - Country:US
Mailing Address - Phone:419-531-5544
Mailing Address - Fax:419-531-5117
Practice Address - Street 1:111 S BYRNE RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-6212
Practice Address - Country:US
Practice Address - Phone:419-531-5544
Practice Address - Fax:412-953-1511
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator