Organization
SUMMIT SURGICAL SUITES, LLC
Active
Other names
Southwest Surgical Suites
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTY MUSIC (DIRECTOR OF PROVIDER ENROLLMENT-AO)
(615) 465-7377
Entity
Organization
Contact information
Practice address
7920 W JEFFERSON BLVD, SUITE 210, FORT WAYNE, IN 46804-4168
(260) 434-2022
(260) 434-2023
Mailing address
7920 W JEFFERSON BLVD, SUITE 210, FORT WAYNE, IN 46804-4168
(260) 434-2022
(260) 434-2023
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
05-003212-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13443
PHP PROVIDER NUMBER
IN
05
—
200413500
—
IN
Enumeration date
08/09/2005
Last updated
08/12/2024
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