MEDICARE: SUMMIT ACADEMY COMMUNITY SCHOOL TOLEDO

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	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1497949994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT ACADEMY COMMUNITY SCHOOL TOLEDO

Provider Business Mailing Address
First Line	:	1111 W MARKET ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44313-7122
Country	:	US
Telephone Number	:	330-836-6200
Fax Number	:	330-836-8216

Provider Business Practice Location Address
First Line	:	3891 MARTHA AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43612-1250
Country	:	US
Telephone Number	:	419-476-0784
Fax Number	:	419-476-0763

Authorized Official
Title or Position	:	CFO
Name	:	MR. GERALD P HOLZAPFEL
Credential	:
Telephone Number	:	330-836-6200

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	08/29/2007

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