MEDICARE: SUMMIT SURGEONS, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1164551743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT SURGEONS, LLC

Provider Business Mailing Address
First Line	:	2257 TAYLOR RD
Second Line	:	SUITE 200
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-7790
Country	:	US
Telephone Number	:	334-270-9914
Fax Number	:	334-270-3195

Provider Business Practice Location Address
First Line	:	1810 STADIUM DR
Second Line	:	SUITE 130
City	:	PHENIX CITY
State	:	AL
Zip	:	36867-3100
Country	:	US
Telephone Number	:	334-448-4123
Fax Number	:	334-448-4228

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RONALD J BARRETTE
Credential	:	DO
Telephone Number	:	334-448-4123

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	10/12/2007

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