MEDICARE: SUMMIT MATERNITY CARE CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1265043889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT MATERNITY CARE CENTER

Provider Business Mailing Address
First Line	:	950 TAMIAMI TRL UNIT 101
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33953-3102
Country	:	US
Telephone Number	:	941-264-6084
Fax Number	:	570-227-2306

Provider Business Practice Location Address
First Line	:	950 TAMIAMI TRL UNIT 101
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33953-3102
Country	:	US
Telephone Number	:	941-264-6084
Fax Number	:	570-227-2306

Authorized Official
Title or Position	:	MIDWIFE
Name	:	DEBORAH FUENTES
Credential	:	LM, CPM
Telephone Number	:	941-264-6084

Provider Enumeration Date	:	08/17/2020
Last Update Date	:	08/17/2020

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Directions to “SUMMIT MATERNITY CARE CENTER ” Practice Location

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