Provider Demographics
NPI:1538591235
Name:SUMMIT THERAPEUTICS LLC
Entity type:Organization
Organization Name:SUMMIT THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:JOANN
Authorized Official - Last Name:SCOTT-WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:OTD
Authorized Official - Phone:907-232-7976
Mailing Address - Street 1:1700 E BOGARD RD STE A101
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6563
Mailing Address - Country:US
Mailing Address - Phone:907-232-7976
Mailing Address - Fax:907-357-7727
Practice Address - Street 1:1700 E BOGARD RD STE A101
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6563
Practice Address - Country:US
Practice Address - Phone:907-232-7976
Practice Address - Fax:907-357-7727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOT0056Medicaid