Healthcare Provider Details

I. General information

NPI: 1073584587
Provider Name (Legal Business Name): SUMMIT RADIOLOGY P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7221 ENGLE RD STE 220
FORT WAYNE IN
46804-2233
US

IV. Provider business mailing address

7221 ENGLE RD STE 220
FORT WAYNE IN
46804-2233
US

V. Phone/Fax

Practice location:
  • Phone: 260-432-1568
  • Fax: 260-432-4969
Mailing address:
  • Phone: 260-432-1568
  • Fax: 260-432-4969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: FRAN E EVISTON
Title or Position: CEO
Credential:
Phone: 260-469-8229