Healthcare Provider Details

I. General information

NPI: 1437589363
Provider Name (Legal Business Name): SUMMIT NEUROLOGY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2013
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3971 BIG HORN RD SUITE 7DD
VAIL CO
81657-4783
US

IV. Provider business mailing address

PO BOX 3727
EAGLE CO
81631-3727
US

V. Phone/Fax

Practice location:
  • Phone: 970-477-0700
  • Fax: 970-777-5161
Mailing address:
  • Phone: 970-477-0700
  • Fax: 970-777-5161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number0052878
License Number StateCO

VIII. Authorized Official

Name: MARK PITHAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 970-477-0700