Healthcare Provider Details

I. General information

NPI: 1740225887
Provider Name (Legal Business Name): SUMMIT PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 CENTRAL PIKE
HERMITAGE TN
37076-3410
US

IV. Provider business mailing address

3939 CENTRAL PIKE
HERMITAGE TN
37076-3410
US

V. Phone/Fax

Practice location:
  • Phone: 615-883-2331
  • Fax: 615-391-1785
Mailing address:
  • Phone: 615-883-2331
  • Fax: 615-391-1785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberMD10309
License Number StateTN

VIII. Authorized Official

Name: WILLIAM DUGAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 615-391-1515