Provider Demographics
NPI:1548505274
Name:SUMMA PHYSICIAN INC
Entity type:Organization
Organization Name:SUMMA PHYSICIAN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR IT SYSTEMS ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:234-312-5193
Mailing Address - Street 1:1077 GORGE BLVD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-2408
Mailing Address - Country:US
Mailing Address - Phone:234-312-5691
Mailing Address - Fax:
Practice Address - Street 1:1305 CORPORATE DR STE A
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-4344
Practice Address - Country:US
Practice Address - Phone:234-867-7606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0080047Medicaid