Provider Demographics
NPI:1740370501
Name:SUMMIT SURGERY AND RECOVERY CARE CENTER INC
Entity type:Organization
Organization Name:SUMMIT SURGERY AND RECOVERY CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:POTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-774-7757
Mailing Address - Street 1:1485 N TURQUOISE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1398
Mailing Address - Country:US
Mailing Address - Phone:928-774-7757
Mailing Address - Fax:928-774-7767
Practice Address - Street 1:1485 N TURQUOISE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1397
Practice Address - Country:US
Practice Address - Phone:928-774-7757
Practice Address - Fax:928-774-7767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC0056261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical