Provider Demographics
NPI:1902597008
Name:SUMMIT PSYCHIATRY LLC
Entity Type:Organization
Organization Name:SUMMIT PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:WINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-410-5123
Mailing Address - Street 1:1401 DOUG BAKER BLVD STE 107-190
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4974
Mailing Address - Country:US
Mailing Address - Phone:205-410-5123
Mailing Address - Fax:
Practice Address - Street 1:1 PERIMETER PARK S STE 486N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3239
Practice Address - Country:US
Practice Address - Phone:205-807-9343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty