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General NPI Number Information
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NPI Number | 1356962849
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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 | 05/06/2020
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 799 E HAMPDEN AVE STE 315
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City | ENGLEWOOD
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State | CO
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Zip | 80113-2762
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Country | US
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Telephone | 303-993-5651
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5300
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City | COLORADO SPRINGS
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State | CO
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Zip | 80931-5300
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Country | US
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Telephone | 303-253-0896
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MITCH O'NEILL
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Credential |
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Telephone | 303-993-5651
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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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