Provider Demographics
NPI:1770985335
Name:SUMMIT MEDICAL CENTER PHYSICIANS TWO, LLC
Entity type:Organization
Organization Name:SUMMIT MEDICAL CENTER PHYSICIANS TWO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WADDAH
Authorized Official - Middle Name:
Authorized Official - Last Name:NASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-470-6900
Mailing Address - Street 1:PO BOX 258831
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73125-8831
Mailing Address - Country:US
Mailing Address - Phone:405-470-6900
Mailing Address - Fax:405-470-6901
Practice Address - Street 1:7221 W HEFNER RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-4505
Practice Address - Country:US
Practice Address - Phone:405-359-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT MEDICAL CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-25
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty