Provider Demographics
NPI:1942701693
Name:SUMMIT HEALTHCARE MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:SUMMIT HEALTHCARE MEDICAL ASSOCIATES
Other - Org Name:SUMMIT HEALTHCARE PEDIATRICS
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF PRACTICE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-537-4375
Mailing Address - Street 1:PO BOX 3050
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85902-3050
Mailing Address - Country:US
Mailing Address - Phone:928-537-6393
Mailing Address - Fax:928-537-6725
Practice Address - Street 1:4951 S WHITE MOUNTAIN RD BLDG A
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7801
Practice Address - Country:US
Practice Address - Phone:289-537-6700
Practice Address - Fax:928-532-2159
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT HEALTHCARE ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-27
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health