Healthcare Provider Details

I. General information

NPI: 1073526208
Provider Name (Legal Business Name): SUMMIT SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 SAGEMORE DRIVE SUITE 106
MARLTON NJ
08053
US

IV. Provider business mailing address

200 BOWMAN DRIVE SUITE D160
VOORHEES NJ
08043
US

V. Phone/Fax

Practice location:
  • Phone: 856-983-4263
  • Fax: 856-983-9362
Mailing address:
  • Phone: 856-247-7838
  • Fax: 856-247-7858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number24019
License Number StateNJ

VIII. Authorized Official

Name: STEPHANIE FENDRICK
Title or Position: CO-CHAIR
Credential:
Phone: 856-247-7838