Provider Demographics
NPI:1104343581
Name:SUMMIT PHYSICIAN GROUP LLP
Entity type:Organization
Organization Name:SUMMIT PHYSICIAN GROUP LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:OLEKSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUHLIAKIVSKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-343-6979
Mailing Address - Street 1:1655 MCFARLAND BLVD N
Mailing Address - Street 2:PO BOX 189
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2212
Mailing Address - Country:US
Mailing Address - Phone:205-343-6979
Mailing Address - Fax:205-490-2374
Practice Address - Street 1:657 HELEN KELLER BLVD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-2983
Practice Address - Country:US
Practice Address - Phone:205-343-6979
Practice Address - Fax:205-490-2374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-25
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty