| Summit Medical Clinic, Pc | |
|
1380 E Fillmore St 100 Colorado Springs CO 80907-6460 | |
| (719) 630-1006 | |
| (719) 630-0688 |
| Full Name | Summit Medical Clinic, Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1380 E Fillmore St, Colorado Springs, Colorado |
| Authorized Official Name and Position | Pratheep Arora (PRESIDENT) |
| Authorized Official Contact | 7196301006 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Summit Medical Clinic, Pc 1380 E Fillmore St 100 Colorado Springs CO 80907-6460 Ph: (719) 630-1006 | Summit Medical Clinic, Pc 1380 E Fillmore St 100 Colorado Springs CO 80907-6460 Ph: (719) 630-1006 |
| NPI Number | 1992709653 |
|---|---|
| Provider Enumeration Date | 06/10/2005 |
| Last Update Date | 05/04/2023 |
| Medicare PECOS PAC ID | 1355331661 |
|---|---|
| Medicare Enrollment ID | O20040517001230 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992709653 | NPI | - | NPPES |
| CM 5708 | Other | CO | MEDICARE # |
| 82327076 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 0000 (Colorado) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Pratheep Arora |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467475616 PECOS PAC ID: 2668472747 Enrollment ID: I20070115000227 |
| Provider Name | Borghild D Kalford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669642971 PECOS PAC ID: 4486836111 Enrollment ID: I20110316000741 |
| Provider Name | Jessi Lynn Lamb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013421890 PECOS PAC ID: 5092074278 Enrollment ID: I20180116000575 |
| Provider Name | Keshea C Desmornes Rouse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467019364 PECOS PAC ID: 3971837238 Enrollment ID: I20190620002423 |
| Provider Name | Neida L. Blondet |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669014593 PECOS PAC ID: 8921432147 Enrollment ID: I20191221000622 |
| Provider Name | Daniel O'shea |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497085989 PECOS PAC ID: 1850711953 Enrollment ID: I20201012000495 |
| Provider Name | Larisa A. Sychova |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992147169 PECOS PAC ID: 5698902286 Enrollment ID: I20201110001713 |
| Provider Name | Tracey Putz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114518693 PECOS PAC ID: 4284946278 Enrollment ID: I20210622000058 |
| Provider Name | Tarah Thevenot |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275146524 PECOS PAC ID: 4688087414 Enrollment ID: I20220317001928 |
| Provider Name | Mary G Levy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245914001 PECOS PAC ID: 2961598230 Enrollment ID: I20230809000070 |
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