=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073526208
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUMMIT SURGICAL CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2006
-----------------------------------------------------
Last Update Date | 03/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5000 SAGEMORE DRIVE SUITE 106
-----------------------------------------------------
City | MARLTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-983-4263
-----------------------------------------------------
Fax | 856-983-9362
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 BOWMAN DRIVE SUITE D160
-----------------------------------------------------
City | VOORHEES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-247-7838
-----------------------------------------------------
Fax | 856-247-7858
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-CHAIR
-----------------------------------------------------
Name | STEPHANIE FENDRICK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 856-247-7838
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 24019
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------