Provider Demographics
NPI:1538184726
Name:SUMMIT SURGICAL, PC
Entity type:Organization
Organization Name:SUMMIT SURGICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEADE
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-996-1219
Mailing Address - Street 1:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:PA
Mailing Address - Zip Code:18471-0303
Mailing Address - Country:US
Mailing Address - Phone:570-996-1219
Mailing Address - Fax:
Practice Address - Street 1:71 HOLLOW CREST RD
Practice Address - Street 2:SUITE3
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-6669
Practice Address - Country:US
Practice Address - Phone:570-996-1219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047076L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA072689Medicare ID - Type Unspecified