Provider Demographics
NPI:1245062447
Name:SUMMIT NUTRITION, LLC
Entity type:Organization
Organization Name:SUMMIT NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ECHO
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CSR, LD, CD
Authorized Official - Phone:208-425-1882
Mailing Address - Street 1:1733 N MINAM LOOP
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-1601
Mailing Address - Country:US
Mailing Address - Phone:208-425-1882
Mailing Address - Fax:
Practice Address - Street 1:1733 N MINAM LOOP
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-1601
Practice Address - Country:US
Practice Address - Phone:208-691-3488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Multi-Specialty