| Summit Family Medical Center | |
|
902 N Hershey Rd Bloomington IL 61704 | |
| (309) 662-6880 | |
| (309) 662-7385 |
| Full Name | Summit Family Medical Center |
|---|---|
| Speciality | Family Medicine |
| Location | 902 N Hershey Rd, Bloomington, Illinois |
| Authorized Official Name and Position | Kenneth W Birge (OWNER) |
| Authorized Official Contact | 3096626880 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Summit Family Medical Center 902 N Hershey Rd Bloomington IL 61704 Ph: (309) 662-6880 | Summit Family Medical Center 902 N Hershey Rd Bloomington IL 61704 Ph: (309) 662-6880 |
| NPI Number | 1174718050 |
|---|---|
| Provider Enumeration Date | 09/13/2007 |
| Last Update Date | 09/13/2007 |
| Medicare PECOS PAC ID | 6406755917 |
|---|---|
| Medicare Enrollment ID | O20040105000252 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174718050 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Illinois) | Primary |
| Provider Name | Kenneth Wayne Birge |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194896720 PECOS PAC ID: 5799816708 Enrollment ID: I20100707000547 |
| Provider Name | Elizabeth Devlin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346760253 PECOS PAC ID: 7315292232 Enrollment ID: I20180618002751 |
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