Healthcare Provider Details

I. General information

NPI: 1487564233
Provider Name (Legal Business Name): SUMMIT SURGICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 W CENTRAL AVE STE 1
WICHITA KS
67212-3661
US

IV. Provider business mailing address

1818 E 23RD AVE
HUTCHINSON KS
67502-1106
US

V. Phone/Fax

Practice location:
  • Phone: 316-721-4910
  • Fax: 316-721-8307
Mailing address:
  • Phone: 620-662-6000
  • Fax: 620-663-4803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: NICOLE HERRERA
Title or Position: REV CYCLE DIRECTOR
Credential:
Phone: 620-662-1907