MEDICARE: SUMMIT INTEGRATED HEALTH 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
1	261Q00000X	Clinic/Center
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1962070276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT INTEGRATED HEALTH PLLC

Provider Business Mailing Address
First Line	:	1465 KELLY JOHNSON BLVD STE 110
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3945
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2997 BROADMOOR VALLEY RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4405
Country	:	US
Telephone Number	:	719-445-6077
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHANNON DARROW
Credential	:
Telephone Number	:	404-447-9945

Provider Enumeration Date	:	06/14/2021
Last Update Date	:	06/14/2021

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Directions to “SUMMIT INTEGRATED HEALTH PLLC ” Practice Location

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