| Organization Name: | SUMMIT MEDICAL GROUP |
| NPI Number: | 1164788261 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GLENN LOOMIS (PRESIDENT/CEO) |
| Mailing Address: | 340 Thomas More Pkwy Su. 160a Crestview Hills |
| State: | KY US |
| Postal Code: | 410175100 |
| Phone Number: | 8593346466 |
| Fax Number: | 8593447930 |
| NPI Enumeration Date: | 04/03/2012 |
| NPI Last Update Date: | 04/05/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |