Provider Demographics
NPI:1255419255
Name:SUMMIT PRIMARY CARE
Entity type:Organization
Organization Name:SUMMIT PRIMARY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DUGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:615-391-1515
Mailing Address - Street 1:3939 CENTRAL PIKE
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3499
Mailing Address - Country:US
Mailing Address - Phone:615-391-1515
Mailing Address - Fax:615-391-1785
Practice Address - Street 1:3939 CENTRAL PIKE
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3499
Practice Address - Country:US
Practice Address - Phone:615-883-2331
Practice Address - Fax:615-391-1785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
44D0903784OtherCLIA #
27034OtherCAQH
3719493OtherGROUP MEDICARE