Provider Demographics
NPI:1962045096
Name:SUMMIT BRAIN AND SPINE PC
Entity Type:Organization
Organization Name:SUMMIT BRAIN AND SPINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROSURGEON
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:385-345-3560
Mailing Address - Street 1:3000 N TRIUMPH BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-4999
Mailing Address - Country:US
Mailing Address - Phone:385-345-3560
Mailing Address - Fax:385-351-3647
Practice Address - Street 1:3000 N TRIUMPH BLVD STE 330
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-4999
Practice Address - Country:US
Practice Address - Phone:385-345-3560
Practice Address - Fax:877-331-0467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-22
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty