Provider Demographics
NPI:1932672458
Name:SUMMT MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:SUMMT MEDICAL GROUP, INC
Other - Org Name:ST. ELIZABETH PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AVP REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RANKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-655-2583
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:812-496-3290
Mailing Address - Fax:812-537-0400
Practice Address - Street 1:1640 FLOSSIE DRIVE
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:IN
Practice Address - Zip Code:47025
Practice Address - Country:US
Practice Address - Phone:812-496-3290
Practice Address - Fax:812-537-0400
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMT MEDICAL GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care