MEDICARE: JANICE SUMMERS

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	310400000X	Assisted Living Facility	AL9402	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972904381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE SUMMERS

Provider Business Mailing Address
First Line	:	1225 SW GRANDVIEW ST
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-0740
Country	:	US
Telephone Number	:	386-466-0005
Fax Number	:	386-438-5368

Provider Business Practice Location Address
First Line	:	1225 SW GRANDVIEW ST
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-0740
Country	:	US
Telephone Number	:	386-466-0005
Fax Number	:	386-438-5368

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2014
Last Update Date	:	09/05/2014

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Directions to “ JANICE SUMMERS ” Practice Location

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