Provider Demographics
NPI:1942532825
Name:SUMMIT MEDICAL GROUP
Entity Type:Organization
Organization Name:SUMMIT MEDICAL GROUP
Other - Org Name:DBA PATIENT FIRST DIGESTIVE DISEASE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-957-1080
Mailing Address - Street 1:334 THOMAS MORE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3464
Mailing Address - Country:US
Mailing Address - Phone:859-344-5481
Mailing Address - Fax:859-344-5552
Practice Address - Street 1:340 THOMAS MORE PKWY
Practice Address - Street 2:SUITE 160 B
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5100
Practice Address - Country:US
Practice Address - Phone:859-331-6466
Practice Address - Fax:859-331-1932
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-03
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY300131261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00815268OtherRAILRAOD MEDICARE
KY7100123490Medicaid
P00815268OtherRAILRAOD MEDICARE