Healthcare Provider Details

I. General information

NPI: 1982998340
Provider Name (Legal Business Name): SUMMIT HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 06/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 E FLORIDA ST
DEMING NM
88030-5310
US

IV. Provider business mailing address

722 E FLORIDA ST
DEMING NM
88030-5310
US

V. Phone/Fax

Practice location:
  • Phone: 575-546-2555
  • Fax: 575-546-2725
Mailing address:
  • Phone: 575-546-2555
  • Fax: 575-546-2725

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: JOEL B STEVENS
Title or Position: OWNER
Credential: NP-C
Phone: 575-546-2555