Healthcare Provider Details

I. General information

NPI: 1326549031
Provider Name (Legal Business Name): SUMMIT HEALTHCARE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2352 QUARTER HORSE TRAIL
OVERGAARD AZ
85933
US

IV. Provider business mailing address

2352 QUARTER HORSE TRAIL
OVERGAARD AZ
85933
US

V. Phone/Fax

Practice location:
  • Phone: 928-537-6910
  • Fax: 952-653-2540
Mailing address:
  • Phone: 928-537-6910
  • Fax: 952-653-2540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberOTC8162
License Number StateAZ

VIII. Authorized Official

Name: AARON YOUNG
Title or Position: ADMINISTRATOR
Credential:
Phone: 928-537-6389