Provider Demographics
NPI:1801937065
Name:SUMMIT MEDICAL
Entity type:Organization
Organization Name:SUMMIT MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:TUNISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-525-5155
Mailing Address - Street 1:2321 NE INDEPENDENCE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-2363
Mailing Address - Country:US
Mailing Address - Phone:816-525-5155
Mailing Address - Fax:816-525-0401
Practice Address - Street 1:2321 NE INDEPENDENCE AVE STE C
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2363
Practice Address - Country:US
Practice Address - Phone:816-525-5155
Practice Address - Fax:816-525-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005002804332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1077240001Medicare NSC