Provider Demographics
NPI:1386754273
Name:SILVER SUMMIT MEDICAL CORPORATION
Entity type:Organization
Organization Name:SILVER SUMMIT MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DULCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOMELI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-324-4100
Mailing Address - Street 1:PO BOX 748792
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-8792
Mailing Address - Country:US
Mailing Address - Phone:661-324-4100
Mailing Address - Fax:661-324-4600
Practice Address - Street 1:5020 COMMERCE DR STE A
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0631
Practice Address - Country:US
Practice Address - Phone:661-324-4100
Practice Address - Fax:661-324-4600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CA207RC0000X, 207RI0011X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0071832OtherMEDI-CAL PROVIDER NUMBER
CAZZZ15436ZOtherMEDICARE PROVIDER NUMBER
CAZZZ20790ZOtherMEDICARE PROVIDER NUMBER
CAZZZ13353ZOtherMEDICARE PROVIDER NUMBER
CAZZZ16171ZOtherMEDICARE PROVIDER NUMBER
CAGR0071830Medicaid
CAGR0071830Medicaid
CAGR0071830Medicaid
CAZZZ15436ZOtherMEDICARE PROVIDER NUMBER
CAZZZ13351ZMedicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER