Healthcare Provider Details

I. General information

NPI: 1598197691
Provider Name (Legal Business Name): SUMMIT MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2765 CHAPEL PL SU. 200
CRESTVIEW HILLS KY
41017-3413
US

IV. Provider business mailing address

2300 CHAMBER CENTER DR SUITE 200
LAKESIDE PARK KY
41017-1673
US

V. Phone/Fax

Practice location:
  • Phone: 859-578-3400
  • Fax: 859-957-0055
Mailing address:
  • Phone: 859-344-5555
  • Fax: 859-344-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GLENN LOMIS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 859-344-3733