Healthcare Provider Details

I. General information

NPI: 1174451215
Provider Name (Legal Business Name): SUMMIT INSTITUTE OF ILLINOIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 W UNION HILLS DR # 41340
PHOENIX AZ
85027-5984
US

IV. Provider business mailing address

1902 W UNION HILLS DR # 41340
PHOENIX AZ
85027-5984
US

V. Phone/Fax

Practice location:
  • Phone: 623-320-0660
  • Fax: 623-320-0670
Mailing address:
  • Phone: 623-320-0660
  • Fax: 623-320-0670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: WILL THOMPSON
Title or Position: CEO
Credential:
Phone: 623-320-0660