MEDICARE: SUMMIT MEDICAL GROUP, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207P00000X	Emergency Medicine Physician
2	207Q00000X	Family Medicine Physician
3	261QU0200X	Urgent Care Clinic/Center
4	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1083035299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	2300 CHAMBER CENTER DR
Second Line	:	SUITE 200
City	:	LAKESIDE PARK
State	:	KY
Zip	:	41017-1673
Country	:	US
Telephone Number	:	859-344-5555
Fax Number	:	859-344-5552

Provider Business Practice Location Address
First Line	:	2091 N BEND RD
Second Line	:
City	:	HEBRON
State	:	KY
Zip	:	41048-9691
Country	:	US
Telephone Number	:	859-586-2200
Fax Number	:	859-856-4222

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	GLENN LOOMIS
Credential	:
Telephone Number	:	859-344-3733

Provider Enumeration Date	:	12/16/2013
Last Update Date	:	12/16/2013

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Directions to “SUMMIT MEDICAL GROUP, INC ” Practice Location

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