Healthcare Provider Details

I. General information

NPI: 1790042430
Provider Name (Legal Business Name): SUMMIT MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 ALEXANDRIA PIKE
HIGHLAND HEIGHTS KY
41076-1530
US

IV. Provider business mailing address

1360 DOLWICK DRIVE
ERLANGER KY
41018
US

V. Phone/Fax

Practice location:
  • Phone: 859-781-4111
  • Fax: 859-441-5214
Mailing address:
  • Phone: 859-344-5555
  • Fax: 859-344-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIA RANKIN
Title or Position: AVP-REVENUE CYCLE
Credential:
Phone: 859-344-5555