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General NPI Number Information
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NPI Number | 1023992203
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Entity Type | Organization
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Legal Business Name | SUMMIT PSYCHIATRIC SERVICES LLC
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Dates
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Enumeration Date | 08/01/2025
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 1025 W RUDISILL BLVD STE 229
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City | FORT WAYNE
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State | IN
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Zip | 46807-2168
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Country | US
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Telephone | 260-433-8583
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Fax |
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Provider Business Mailing Address
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Address Line | 14826 GATESIDE DR
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City | FORT WAYNE
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State | IN
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Zip | 46814-7574
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PMHNP
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Name | HEATHER R BLOOMFIELD
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Credential | NP
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Telephone | 260-610-3808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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