Provider Demographics
NPI:1740371665
Name:SUMMIT SURGICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:SUMMIT SURGICAL ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KRAWCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-859-9988
Mailing Address - Street 1:416 N BEDFORD DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4318
Mailing Address - Country:US
Mailing Address - Phone:310-275-5566
Mailing Address - Fax:310-271-0521
Practice Address - Street 1:416 N BEDFORD DR STE 400
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4318
Practice Address - Country:US
Practice Address - Phone:310-275-5566
Practice Address - Fax:310-271-0521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2276OtherASF CERT NUMBER
2276OtherASF CERT NUMBER