Healthcare Provider Details

I. General information

NPI: 1164995544
Provider Name (Legal Business Name): SUMMIT MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 GRAND AVENUE
NEWPORT KY
41071
US

IV. Provider business mailing address

1360 DOLWICK DRIVE
ERIANGER KY
41018
US

V. Phone/Fax

Practice location:
  • Phone: 859-212-0497
  • Fax: 859-441-1575
Mailing address:
  • Phone: 859-344-5555
  • Fax: 859-344-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

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