Healthcare Provider Details

I. General information

NPI: 1740833243
Provider Name (Legal Business Name): SUMMITS HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 01/01/2024
Certification Date: 01/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N PEARL ST
DEMING NM
88030-3835
US

IV. Provider business mailing address

111 N PEARL ST
DEMING NM
88030-3835
US

V. Phone/Fax

Practice location:
  • Phone: 575-517-2725
  • Fax: 575-517-2280
Mailing address:
  • Phone: 575-517-2725
  • Fax: 575-517-2280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EDUARD SCHANDER
Title or Position: OWNER/PROVIDER
Credential: CNP
Phone: 717-331-4676