MEDICARE: SUMMIT HEALTH, LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1639490865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT HEALTH, LLC

Provider Business Mailing Address
First Line	:	19820 N 7TH AVE
Second Line	:	SUITE 230-G
City	:	PHOENIX
State	:	AZ
Zip	:	85027-4736
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19820 N 7TH AVE
Second Line	:	SUITE 230-G
City	:	PHOENIX
State	:	AZ
Zip	:	85027-4736
Country	:	US
Telephone Number	:	602-265-0077
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	BRANDON MAXON MALDONADO
Credential	:
Telephone Number	:	602-265-0077

Provider Enumeration Date	:	06/22/2010
Last Update Date	:	10/12/2012

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Directions to “SUMMIT HEALTH, LLC ” Practice Location

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