| Summit Specialty Physicians Inc | |
|
653 N Town Center Dr Ste 506 Las Vegas NV 89144-0519 | |
| (617) 895-7644 | |
| Not Available |
| Full Name | Summit Specialty Physicians Inc |
|---|---|
| Speciality | Surgery |
| Location | 653 N Town Center Dr Ste 506, Las Vegas, Nevada |
| Authorized Official Name and Position | Amy Carolyn Joseph (CEO) |
| Authorized Official Contact | 2039130661 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Summit Specialty Physicians Inc 153 S Ring Dove Dr Las Vegas NV 89144-4351 Ph: (617) 895-7644 | Summit Specialty Physicians Inc 653 N Town Center Dr Ste 506 Las Vegas NV 89144-0519 Ph: (617) 895-7644 |
| NPI Number | 1679219349 |
|---|---|
| Provider Enumeration Date | 05/06/2022 |
| Last Update Date | 01/23/2024 |
| Medicare PECOS PAC ID | 0143600403 |
|---|---|
| Medicare Enrollment ID | O20220703000101 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679219349 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 208600000X | Surgery | (* (Not Available)) | Primary |
| Provider Name | Saju Joseph |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1083870554 PECOS PAC ID: 6507924735 Enrollment ID: I20190702001618 |
| Provider Name | Clyde Ellis |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1093762908 PECOS PAC ID: 4082699376 Enrollment ID: I20191204001702 |
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