Healthcare Provider Details

I. General information

NPI: 1922574854
Provider Name (Legal Business Name): SUMMIT MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W 18TH ST
COVINGTON KY
41011-3329
US

IV. Provider business mailing address

P.O. BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-757-0717
  • Fax: 859-331-2425
Mailing address:
  • Phone: 859-757-0717
  • Fax: 859-331-2425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARIA RANKIN
Title or Position: AVP -REVENUE CYCLE
Credential:
Phone: 859-344-5525