Provider Demographics
NPI:1699910349
Name:SUMMIT PROSTHETICS & ORTHOTICS
Entity type:Organization
Organization Name:SUMMIT PROSTHETICS & ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:DRISCOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-812-0153
Mailing Address - Street 1:1006 PROCURE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-2627
Mailing Address - Country:US
Mailing Address - Phone:919-552-1464
Mailing Address - Fax:919-552-1465
Practice Address - Street 1:1006 PROCURE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2627
Practice Address - Country:US
Practice Address - Phone:919-552-1464
Practice Address - Fax:919-552-1465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECPO02014335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier