Provider Demographics
NPI:1972640282
Name:SUMMIT RADIOLOGY, LLC
Entity Type:Organization
Organization Name:SUMMIT RADIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-519-2600
Mailing Address - Street 1:3849 N PERRYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-8080
Mailing Address - Country:US
Mailing Address - Phone:815-654-2486
Mailing Address - Fax:815-654-2680
Practice Address - Street 1:3849 N PERRYVILLE RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-8080
Practice Address - Country:US
Practice Address - Phone:815-654-2486
Practice Address - Fax:815-654-2680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty