# SUMMIT MEMORIAL MEDICAL GROUP LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598469462
- **Authorized official:** JAMES CUSSINS (CFO)
- **Authorized official phone:** (307) 286-6738

## Contact information

- **Practice address:** 6500 E 2ND ST, CASPER, WY 82609-4338
- **Practice address phone:** (307) 577-1000
- **Mailing address:** 222 S 5TH ST, DOUGLAS, WY 82633-2534
- **Mailing address phone:** (307) 358-1459

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/27/2023
- **Last updated:** 10/16/2024