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NPI Code Detail

MEDICARE: SUMMIT MEDICAL GROUP, PLLC

MEDICARE: SUMMIT MEDICAL GROUP, PLLC
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
1332900000XNon-Pharmacy Dispensing Site20447TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14440119OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1639206212
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUMMIT MEDICAL GROUP, PLLC
Provider Business Mailing Address
First Line : 1275 DICK LONAS RD UNIT 101
Second Line :
City : KNOXVILLE
State : TN
Zip : 37909-1383
Country : US
Telephone Number : 865-500-2144
Fax Number : 865-381-1509
Provider Business Practice Location Address
First Line : 280 FORT SANDERS WEST BLVD STE 101
Second Line :
City : KNOXVILLE
State : TN
Zip : 37922-3352
Country : US
Telephone Number : 865-934-4252
Fax Number : 865-539-1816
Authorized Official
Title or Position : CREDENTIALING COORDINATOR
Name : ZANDRA M MILLS
Credential : BSOM, CPCS
Telephone Number : 865-500-2144
Provider Enumeration Date : 02/28/2007
Last Update Date : 01/19/2021

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