SUMMIT MEDICAL GROUP, INC

Provider Demographics

• NPI: 1750343216
• Name: SUMMIT MEDICAL GROUP, INC
• Entity type: Organization
• Organization Name: SUMMIT MEDICAL GROUP, INC
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: AVP-REVENUE CYCLE
• Authorized Official - First Name: MARIA
• Authorized Official - Last Name: RANKIN
• Authorized Official - Phone: 859-344-5555
• Mailing Address - Street 1: 1360 DOLWICK DRIVE
• Mailing Address - City: ERLANGER
• Mailing Address - State: KY
• Mailing Address - Zip Code: 41018-3127
• Mailing Address - Country: US
• Mailing Address - Phone: 859-344-5555
• Mailing Address - Fax: 859-344-5552
• Practice Address - Street 1: 1360 DOLWICK DRIVE
• Practice Address - City: ERLANGER
• Practice Address - State: KY
• Practice Address - Zip Code: 41018-3127
• Practice Address - Country: US
• Practice Address - Phone: 859-344-5555
• Practice Address - Fax: 859-344-5552
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-04-03
• Last Update Date: 2020-09-08

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	101YM0800X	Behavioral Health & Social Service Providers	Counselor	Mental Health	Group - Multi-Specialty
No	103T00000X	Behavioral Health & Social Service Providers	Psychologist		Group - Multi-Specialty
No	104100000X	Behavioral Health & Social Service Providers	Social Worker		Group - Multi-Specialty
No	106H00000X	Behavioral Health & Social Service Providers	Marriage & Family Therapist		Group - Multi-Specialty
No	133V00000X	Dietary & Nutritional Service Providers	Dietitian, Registered		Group - Multi-Specialty
No	152W00000X	Eye and Vision Services Providers	Optometrist		Group - Multi-Specialty
No	213ES0103X	Podiatric Medicine & Surgery Service Providers	Podiatrist	Foot & Ankle Surgery	Group - Multi-Specialty
No	261QU0200X	Ambulatory Health Care Facilities	Clinic/Center	Urgent Care	Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
OH	2355115	Medicaid
IN	2501152300	Medicaid
IN	200993310	Medicaid
IN	201157570	Medicaid
KY	7100235410	Medicaid
KY	78003852	Medicaid
KY	CC3684	Other	RAILROAD
IN	201152300	Medicaid
KY	7100018930	Medicaid
OH	DQ9133	Other	RAILROAD
KY	65926743	Medicaid
KY	7100235400	Medicaid
KY	7100271890	Medicaid
KY	7100311260	Medicaid
IN	DR8623	Other	RAILROAD
KY	78902020	Medicaid