Provider Demographics
NPI:1518713486
Name:SUMMIT MEDICAL SUPPLY CORPORATION
Entity type:Organization
Organization Name:SUMMIT MEDICAL SUPPLY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BONENFANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-520-5031
Mailing Address - Street 1:127 ROUTE 28 STE 16
Mailing Address - Street 2:
Mailing Address - City:OSSIPEE
Mailing Address - State:NH
Mailing Address - Zip Code:03864-7300
Mailing Address - Country:US
Mailing Address - Phone:603-945-9099
Mailing Address - Fax:603-600-0906
Practice Address - Street 1:127 ROUTE 28 STE 16
Practice Address - Street 2:
Practice Address - City:OSSIPEE
Practice Address - State:NH
Practice Address - Zip Code:03864-7300
Practice Address - Country:US
Practice Address - Phone:603-945-9099
Practice Address - Fax:603-600-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies