MEDICARE: SUMMIT REHABILITATION MEDICAL ASSOCIATES INC

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	305R00000X	Preferred Provider Organization	G23317	CA
2	305R00000X	Preferred Provider Organization	A73010	CA
3	305R00000X	Preferred Provider Organization	A83769	CA

General Provider Information

NPI Number	:	1609042761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT REHABILITATION MEDICAL ASSOCIATES INC

Provider Business Mailing Address
First Line	:	729 SUNRISE AVENUE
Second Line	:	SUITE 602
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-4542
Country	:	US
Telephone Number	:	916-781-7882
Fax Number	:	916-781-3787

Provider Business Practice Location Address
First Line	:	729 SUNRISE AVENUE
Second Line	:	SUITE 602
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-4542
Country	:	US
Telephone Number	:	916-781-7882
Fax Number	:	916-781-3787

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KARANJIT BASRAI
Credential	:	M.D.
Telephone Number	:	916-781-7882

Provider Enumeration Date	:	05/07/2008
Last Update Date	:	10/11/2012

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