Healthcare Provider Details

I. General information

NPI: 1679219349
Provider Name (Legal Business Name): SUMMIT SPECIALTY PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 N TOWN CENTER DR STE 506
LAS VEGAS NV
89144-0519
US

IV. Provider business mailing address

153 S RING DOVE DR
LAS VEGAS NV
89144-4351
US

V. Phone/Fax

Practice location:
  • Phone: 617-895-7644
  • Fax:
Mailing address:
  • Phone: 617-895-7644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMY CAROLYN JOSEPH
Title or Position: CEO
Credential:
Phone: 203-913-0661