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General NPI Number Information
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NPI Number | 1770700767
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Entity Type | Organization
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Legal Business Name | SUMMIT HEALTHCARE MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 2352 QUARTER HORSE TRAIL
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City | OVERGAARD
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State | AZ
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Zip | 85933
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Country | US
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Telephone | 928-535-3616
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Fax | 928-532-2156
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Provider Business Mailing Address
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Address Line | 2200 E SHOW LOW LAKE RD
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City | SHOW LOW
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State | AZ
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Zip | 85901-7831
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Country | US
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Telephone | 928-535-3616
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Fax | 928-532-2156
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Authorized Official
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Title or Position | HEALTH PLAN CREDENTIALING COORDINAT
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Name | JILL BLUSE
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Credential |
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Telephone | 928-537-6393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | H0132
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License Number State | AZ
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