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General NPI Number Information
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NPI Number | 1922514165
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Entity Type | Organization
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Legal Business Name | SUMMIT DIAGNOSTICS LLC
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Dates
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Enumeration Date | 12/26/2017
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Last Update Date | 01/10/2018
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Provider Practice Location Address
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Address Line | 3604 CATHEDRAL LAKE DR
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City | FRISCO
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State | TX
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Zip | 75034-3808
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Country | US
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Telephone | 727-501-2280
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Fax |
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Provider Business Mailing Address
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Address Line | 3604 CATHEDRAL LAKE DR
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City | FRISCO
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State | TX
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Zip | 75034-3808
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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 | MANAGER
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Name | KERRI JUNE KOBAKOF
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Credential |
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Telephone | 727-501-2280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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