Healthcare Provider Details

I. General information

NPI: 1679791404
Provider Name (Legal Business Name): SILVER SUMMIT MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 COMMERCIAL WAY
BAKERSFIELD CA
93309-0407
US

IV. Provider business mailing address

PO BOX 748792
LOS ANGELES CA
90074-8792
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-4455
  • Fax:
Mailing address:
  • Phone: 661-864-3664
  • Fax: 661-328-2925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA45356
License Number StateCA

VIII. Authorized Official

Name: MADELINE ANGELA MEYER
Title or Position: DIRECTOR
Credential: PHD
Phone: 321-274-8344