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General NPI Number Information
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NPI Number | 1710877071
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Entity Type | Organization
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Legal Business Name | SUMMIT HEALTH AND WELLNESS
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Dates
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Enumeration Date | 07/08/2025
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 8152 N. WAYNE DR.
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City | HAYDEN
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State | ID
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Zip | 83835
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Country | US
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Telephone | 208-417-7741
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Fax |
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Provider Business Mailing Address
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Address Line | 1940 E GUNTHER AVE
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City | COEUR D ALENE
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State | ID
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Zip | 83815-9435
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KYLE SEVERINSEN
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Credential | MD
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Telephone | 208-417-7741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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