NPI Code Details Logo

NPI 1558625871

NPI 1558625871 : SUMMA PHYSICIANS LLC : WADSWORTH, OH

=====================================================
General NPI Number Information
=====================================================
    NPI Number           |    1558625871
-----------------------------------------------------
    Entity Type          |    Organization 
-----------------------------------------------------
    Legal Business Name  |    SUMMA PHYSICIANS LLC 
-----------------------------------------------------

=====================================================
Dates
=====================================================
    Enumeration Date     |    07/02/2012
-----------------------------------------------------
    Last Update Date     |    10/10/2025
-----------------------------------------------------

=====================================================
Provider Practice Location Address
=====================================================
    Address Line         |    195 WADSWORTH RD 
-----------------------------------------------------
    City                 |    WADSWORTH
-----------------------------------------------------
    State                |    OH
-----------------------------------------------------
    Zip                  |    44281-9504
-----------------------------------------------------
    Country              |    US
-----------------------------------------------------
    Telephone            |    330-374-1255
-----------------------------------------------------
    Fax                  |    330-374-1256
-----------------------------------------------------

=====================================================
Provider Business Mailing Address
=====================================================
    Address Line         |    1077 GORGE BLVD 
-----------------------------------------------------
    City                 |    AKRON
-----------------------------------------------------
    State                |    OH
-----------------------------------------------------
    Zip                  |    44310-2408
-----------------------------------------------------
    Country              |    US
-----------------------------------------------------
    Telephone            |    234-312-5873
-----------------------------------------------------
    Fax                  |    
-----------------------------------------------------

=====================================================
Authorized Official
=====================================================
    Title or Position    |    MANAGER, PAYER ENROLLMENT
-----------------------------------------------------
    Name                 |     WENDY  CARSON 
-----------------------------------------------------
    Credential           |    
-----------------------------------------------------
    Telephone            |    234-312-5691
-----------------------------------------------------

=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
    Taxonomy Code        |    207RG0100X
-----------------------------------------------------
    Taxonomy Name        |    Gastroenterology Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
    Taxonomy Code        |    208600000X
-----------------------------------------------------
    Taxonomy Name        |    Surgery Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
    Taxonomy Code        |    207X00000X
-----------------------------------------------------
    Taxonomy Name        |    Orthopaedic Surgery Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
    Taxonomy Code        |    207RG0300X
-----------------------------------------------------
    Taxonomy Name        |    Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
    Taxonomy Code        |    363L00000X
-----------------------------------------------------
    Taxonomy Name        |    Nurse Practitioner
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
    Taxonomy Code        |    363A00000X
-----------------------------------------------------
    Taxonomy Name        |    Physician Assistant
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
    Taxonomy Code        |    207QG0300X
-----------------------------------------------------
    Taxonomy Name        |    Geriatric Medicine (Family Medicine) Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #8
-----------------------------------------------------
    Taxonomy Code        |    208800000X
-----------------------------------------------------
    Taxonomy Name        |    Urology Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------



                        

Copyright © 2007-2025 Data Labs Health. All rights reserved.