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General NPI Number Information
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NPI Number | 1750035440
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Entity Type | Organization
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Legal Business Name | SUMMIT COMMUNITY CARE CLINIC, INC.
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Dates
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Enumeration Date | 02/10/2022
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 360 PEAK ONE DRIVE SUITE 100A
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City | FRISCO
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State | CO
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Zip | 80443-5948
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Country | US
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Telephone | 970-486-3110
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Fax | 970-486-8476
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Provider Business Mailing Address
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Address Line | 1620 W. NORTHWEST HWY SUITE 100
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City | GRAPEVINE
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State | TX
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Zip | 76051
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Country | US
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Telephone | 817-572-0009
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Fax | 817-572-0221
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Authorized Official
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Title or Position | CEO
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Name | JOSH COGDILL
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Credential | MBA
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Telephone | 970-668-6889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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