Provider Demographics
NPI:1972709699
Name:SUMMA PHYSICIAN INC
Entity type:Organization
Organization Name:SUMMA PHYSICIAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:T CLIFFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVENY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-996-8603
Mailing Address - Street 1:525 E MARKET ST
Mailing Address - Street 2:P.O. BOX 2090
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1619
Mailing Address - Country:US
Mailing Address - Phone:330-996-8603
Mailing Address - Fax:330-996-8695
Practice Address - Street 1:605 N CLEVELAND MASSILLON RD
Practice Address - Street 2:SUITE B
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-2241
Practice Address - Country:US
Practice Address - Phone:330-666-3333
Practice Address - Fax:330-668-6532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2778034Medicaid
OHSU9284141Medicare PIN