Provider Demographics
NPI:1437986254
Name:SUMMIT PSYCHIATRY AND FAMILY WELLNESS
Entity type:Organization
Organization Name:SUMMIT PSYCHIATRY AND FAMILY WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLAIM
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-869-2455
Mailing Address - Street 1:217 W GEORGIA AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6812
Mailing Address - Country:US
Mailing Address - Phone:208-498-1760
Mailing Address - Fax:208-498-1769
Practice Address - Street 1:217 W GEORGIA AVE STE 120
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6812
Practice Address - Country:US
Practice Address - Phone:208-498-1760
Practice Address - Fax:208-498-1769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty