Provider Demographics
NPI:1962545681
Name:SUMMIT ORTHOPAEDICS MANAGEMENT AND CONSULTING, LLC
Entity type:Organization
Organization Name:SUMMIT ORTHOPAEDICS MANAGEMENT AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNY
Authorized Official - Suffix:
Authorized Official - Credentials:MAOM, CMPE
Authorized Official - Phone:208-227-1100
Mailing Address - Street 1:2321 CORONADO ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7407
Mailing Address - Country:US
Mailing Address - Phone:208-227-1100
Mailing Address - Fax:208-227-1087
Practice Address - Street 1:2321 CORONADO ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7407
Practice Address - Country:US
Practice Address - Phone:208-227-1100
Practice Address - Fax:208-227-1087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID4471820001Medicare ID - Type Unspecified