=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932117975
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUMMIT SURGICAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2006
-----------------------------------------------------
Last Update Date | 12/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1818 E 23RD AVE
-----------------------------------------------------
City | HUTCHINSON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-663-4800
-----------------------------------------------------
Fax | 620-663-4803
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1818 E 23RD AVE
-----------------------------------------------------
City | HUTCHINSON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-663-4800
-----------------------------------------------------
Fax | 620-663-4803
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | CHERISE BROWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 620-662-6000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WP0000X
-----------------------------------------------------
Taxonomy Name | Pain Management Registered Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 284300000X
-----------------------------------------------------
Taxonomy Name | Special Hospital
-----------------------------------------------------
License Number | S078004
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------