Provider Demographics
NPI:1750035440
Name:SUMMIT COMMUNITY CARE CLINIC, INC.
Entity type:Organization
Organization Name:SUMMIT COMMUNITY CARE CLINIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:COGDILL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:970-668-6889
Mailing Address - Street 1:1620 W. NORTHWEST HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051
Mailing Address - Country:US
Mailing Address - Phone:817-572-0009
Mailing Address - Fax:817-572-0221
Practice Address - Street 1:360 PEAK ONE DRIVE
Practice Address - Street 2:SUITE 100A
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-5948
Practice Address - Country:US
Practice Address - Phone:970-486-3110
Practice Address - Fax:970-486-8476
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT COMMUNITY CARE CLINIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-10
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO343134Medicaid