Provider Demographics
NPI:1366908808
Name:SUMMIT EMG ASSOCIATES, PLLC
Entity type:Organization
Organization Name:SUMMIT EMG ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-460-7712
Mailing Address - Street 1:216 HOPE DR
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:17007-9584
Mailing Address - Country:US
Mailing Address - Phone:570-332-5026
Mailing Address - Fax:717-706-3476
Practice Address - Street 1:1300 BENT CREEK BLVD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-1871
Practice Address - Country:US
Practice Address - Phone:717-706-3477
Practice Address - Fax:717-706-3476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1023102233OtherINDIVIDUAL NPI
PAWE96128OtherHIGHMARK BLUE SHIELD