Organization
SUMMERLIN OTOLOGY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK D SUMMERLIN MD (PRESIDENT MD)
(317) 923-5439
Entity
Organization
Contact information
Practice address
3351 N MERIDIAN ST, SUITE 100, INDIANAPOLIS, IN 46208-4674
(317) 923-5439
(317) 923-4633
Mailing address
3351 N MERIDIAN ST, SUITE 100, INDIANAPOLIS, IN 46208-4674
(317) 923-5439
(317) 923-4633
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
01017561
IN
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041068120
RAILROAD
IN
05
—
100065670C
—
IN
05
—
100119090A
—
IN
05
—
200891910A
—
IN
Enumeration date
12/30/2005
Last updated
05/12/2008
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