Healthcare Provider Details

I. General information

NPI: 1497125868
Provider Name (Legal Business Name): SUMMIT HEALTH GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2015
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 ROLLING OAKS DR STE 100
THOUSAND OAKS CA
91361-1010
US

IV. Provider business mailing address

55 ROLLING OAKS DR STE 100
THOUSAND OAKS CA
91361-1010
US

V. Phone/Fax

Practice location:
  • Phone: 805-499-4446
  • Fax: 805-499-3636
Mailing address:
  • Phone: 805-499-4446
  • Fax: 805-499-3636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. DANNELLE MCDERMOTT
Title or Position: ADMINISTRATOR
Credential:
Phone: 805-499-4446