=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427067578
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUMMIT MEDICAL CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 360 MARKET ST
-----------------------------------------------------
City | HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06120-2901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-493-6575
-----------------------------------------------------
Fax | 860-493-6583
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 61 UNQUOWA RD
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06824-5096
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-259-8782
-----------------------------------------------------
Fax | 203-259-0834
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INSURANCE SERVICE DIRECTOR
-----------------------------------------------------
Name | JANIE UMBRICHT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 203-259-8782
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | 0013
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------