MEDICARE: SUMMIT SURGERY CENTER 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	261QA1903X	Ambulatory Surgical Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	490004966	OTHER	MT	RAILROAD MEDICARE MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0060582	OTHER	MT	BCBS OF MONTANA
4	0536068	OTHER	MT	TRICARE/CHAMPUS

General Provider Information

NPI Number	:	1770676447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	434 SOUTH CLARK ST.
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-2836
Country	:	US
Telephone Number	:	406-496-3550
Fax Number	:	406-496-3575

Provider Business Practice Location Address
First Line	:	434 SOUTH CLARK ST.
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-2836
Country	:	US
Telephone Number	:	406-496-3550
Fax Number	:	406-496-3575

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. GEORGANN K HAEFFNER
Credential	:	R.N.
Telephone Number	:	406-496-3550

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	09/30/2022

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Directions to “SUMMIT SURGERY CENTER LLC ” Practice Location

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