Healthcare Provider Details

I. General information

NPI: 1275318651
Provider Name (Legal Business Name): SUMMIT HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200B TECHNOLOGY CT
CHANTILLY VA
20151-1214
US

IV. Provider business mailing address

4517 WAVERLY CROSSING LN
CHANTILLY VA
20151-2212
US

V. Phone/Fax

Practice location:
  • Phone: 571-350-0929
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DIANA GRIMSLEY
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 703-231-8355