Provider Demographics
NPI:1427076389
Name:SUMMIT HEALTHCARE INC.
Entity type:Organization
Organization Name:SUMMIT HEALTHCARE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADY
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCCOLLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:479-474-0200
Mailing Address - Street 1:2215 FAYETTEVILLE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-6508
Mailing Address - Country:US
Mailing Address - Phone:479-474-0200
Mailing Address - Fax:479-474-0253
Practice Address - Street 1:2215 FAYETTEVILLE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-6508
Practice Address - Country:US
Practice Address - Phone:479-474-0200
Practice Address - Fax:479-474-0253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 2698225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F350Medicare ID - Type Unspecified