Healthcare Provider Details

I. General information

NPI: 1083736128
Provider Name (Legal Business Name): SUMMIT HEALTHCARE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E HUNT DR STE H-J
SHOW LOW AZ
85901-7954
US

IV. Provider business mailing address

2500 E HUNT ST SUITE H
SHOW LOW AZ
85901-7954
US

V. Phone/Fax

Practice location:
  • Phone: 928-537-6937
  • Fax:
Mailing address:
  • Phone: 928-537-6937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number3376
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number3376
License Number StateAZ

VIII. Authorized Official

Name: DAVID ROTHENBERGER
Title or Position: CFO
Credential:
Phone: 375-928-6375