Provider Demographics
NPI:1437589363
Name:SUMMIT NEUROLOGY P.C.
Entity type:Organization
Organization Name:SUMMIT NEUROLOGY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PITHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-477-0700
Mailing Address - Street 1:PO BOX 3727
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631-3727
Mailing Address - Country:US
Mailing Address - Phone:970-477-0700
Mailing Address - Fax:970-777-5161
Practice Address - Street 1:3971 BIG HORN RD
Practice Address - Street 2:SUITE 7DD
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657-4783
Practice Address - Country:US
Practice Address - Phone:970-477-0700
Practice Address - Fax:970-777-5161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0052878261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty