Provider Demographics
NPI:1447302641
Name:SUMMIT UROLOGY, INC
Entity type:Organization
Organization Name:SUMMIT UROLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-423-2244
Mailing Address - Street 1:1064 SUMMITT SQ
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3400
Mailing Address - Country:US
Mailing Address - Phone:513-423-2244
Mailing Address - Fax:513-423-2004
Practice Address - Street 1:1064 SUMMITT SQ
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3400
Practice Address - Country:US
Practice Address - Phone:513-423-2244
Practice Address - Fax:513-423-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2017329Medicaid
OHF65375Medicare UPIN
OHE92236Medicare UPIN
OH2017329Medicaid