Provider Demographics
NPI:1891407649
Name:SUMMIT SPORTS HEALTH & PERFORMANCE, LLC
Entity Type:Organization
Organization Name:SUMMIT SPORTS HEALTH & PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-714-2290
Mailing Address - Street 1:6612 NW 148TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-7862
Mailing Address - Country:US
Mailing Address - Phone:405-714-2290
Mailing Address - Fax:
Practice Address - Street 1:7312 NW 164TH ST STE 102
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-9055
Practice Address - Country:US
Practice Address - Phone:405-252-1650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service