Healthcare Provider Details

I. General information

NPI: 1083035299
Provider Name (Legal Business Name): SUMMIT MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2013
Last Update Date: 12/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2091 N BEND RD
HEBRON KY
41048-9691
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 859-586-2200
  • Fax: 859-856-4222
Mailing address:
  • Phone: 859-344-5555
  • Fax: 859-344-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

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