Provider Demographics
NPI:1992709653
Name:SUMMIT MEDICAL CLINIC, PC
Entity type:Organization
Organization Name:SUMMIT MEDICAL CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRATHEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:ARORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-630-1006
Mailing Address - Street 1:1380 E FILLMORE ST
Mailing Address - Street 2:100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6460
Mailing Address - Country:US
Mailing Address - Phone:719-630-1006
Mailing Address - Fax:719-630-0688
Practice Address - Street 1:1380 E FILLMORE ST
Practice Address - Street 2:100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6460
Practice Address - Country:US
Practice Address - Phone:719-630-1006
Practice Address - Fax:719-630-0688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000207R00000X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCM 5708OtherMEDICARE #
CO82327076Medicaid