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General NPI Number Information
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NPI Number | 1104343581
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Entity Type | Organization
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Legal Business Name | SUMMIT PHYSICIAN GROUP LLP
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Dates
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Enumeration Date | 08/25/2017
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 657 HELEN KELLER BLVD
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City | TUSCALOOSA
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State | AL
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Zip | 35404-2983
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Country | US
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Telephone | 205-343-6979
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Fax | 205-490-2374
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Provider Business Mailing Address
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Address Line | 1655 MCFARLAND BLVD N PO BOX 189
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City | TUSCALOOSA
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State | AL
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Zip | 35406-2212
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Country | US
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Telephone | 205-343-6979
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Fax | 205-490-2374
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MS. OLEKSANDRA KRUHLIAKIVSKA
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Credential |
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Telephone | 205-343-6979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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