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General NPI Number Information
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NPI Number | 1255419255
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Entity Type | Organization
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Legal Business Name | SUMMIT PRIMARY CARE
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/29/2012
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Provider Practice Location Address
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Address Line | 3939 CENTRAL PIKE
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City | HERMITAGE
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State | TN
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Zip | 37076-3499
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Country | US
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Telephone | 615-883-2331
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Fax | 615-391-1785
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Provider Business Mailing Address
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Address Line | 3939 CENTRAL PIKE
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City | HERMITAGE
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State | TN
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Zip | 37076-3499
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Country | US
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Telephone | 615-391-1515
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Fax | 615-391-1785
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | WILLIAM DUGAN
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Credential | MBA
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Telephone | 615-391-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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