Provider Demographics
NPI:1679791404
Name:SILVER SUMMIT MEDICAL CORPORATION
Entity type:Organization
Organization Name:SILVER SUMMIT MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:321-274-8344
Mailing Address - Street 1:PO BOX 748792
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-8792
Mailing Address - Country:US
Mailing Address - Phone:661-864-3664
Mailing Address - Fax:661-328-2925
Practice Address - Street 1:1408 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0407
Practice Address - Country:US
Practice Address - Phone:661-327-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45356174400000X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR1315FMedicaid
CA1679791404Medicaid
CAZZZ00508ZMedicare PIN