MEDICARE: SUMMIT PRIMARY CARE

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1720861230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT PRIMARY CARE

Provider Business Mailing Address
First Line	:	75 PRINTERS PKWY STE 200
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-3142
Country	:	US
Telephone Number	:	303-993-5651
Fax Number	:	303-552-5730

Provider Business Practice Location Address
First Line	:	2301 E PIKES PEAK AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-8006
Country	:	US
Telephone Number	:	719-373-1212
Fax Number	:	303-552-5730

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MICHELLE ONEILL
Credential	:
Telephone Number	:	303-993-5651

Provider Enumeration Date	:	08/17/2023
Last Update Date	:	01/17/2026

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