Provider Demographics
NPI:1780778456
Name:SUMMITT GROUP, INC
Entity type:Organization
Organization Name:SUMMITT GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROB
Authorized Official - Middle Name:D
Authorized Official - Last Name:SUMMITT
Authorized Official - Suffix:
Authorized Official - Credentials:ATS, CRTS
Authorized Official - Phone:423-893-9121
Mailing Address - Street 1:606 GEORGIA AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-1418
Mailing Address - Country:US
Mailing Address - Phone:423-893-9121
Mailing Address - Fax:423-893-9133
Practice Address - Street 1:606 GEORGIA AVE FL 2
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-1418
Practice Address - Country:US
Practice Address - Phone:423-893-9121
Practice Address - Fax:423-893-9133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000747332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454244Medicaid
TNTN0100OtherPIN JOHN DEERE NAT'L/TNCR
GA52823185OtherPIN BCBS GA STATE EMP
TN890-13447OtherPIN BCBS OF AL
TN00B46OtherPIN STATE TN WAIVER
TNTN0100OtherPIN JOHN DEERE NAT'L/TNCR