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General NPI Number Information
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NPI Number | 1164788261
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Entity Type | Organization
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Legal Business Name | SUMMIT MEDICAL GROUP
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Dates
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Enumeration Date | 04/03/2012
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 340 THOMAS MORE PKWY SU. 160A
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City | CRESTVIEW HILLS
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State | KY
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Zip | 41017-5100
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Country | US
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Telephone | 859-334-6466
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Fax | 859-344-7930
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Provider Business Mailing Address
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Address Line | 2300 CHAMBER CENTER DR SU. 200
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City | LAKESIDE PARK
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State | KY
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Zip | 41017-1673
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Country | US
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Telephone | 859-344-5555
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Fax | 859-344-5552
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | GLENN LOOMIS
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Credential |
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Telephone | 859-344-3733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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