Summit Radiology Services LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

SUMMIT RADIOLOGY SERVICES LLC

Practice address

3738 Landmark Dr.
Suite D
Lafayette, IN 47905-6655

Phone

(765) 449-7984

Fax

(765) 449-9791

NPI assigned

Jul 15, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Glenn A Tuckman, M.D.

Title

President

Phone

(765) 449-7984

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359072000000",
    "number": "1124044607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3738 LANDMARK DR.",
            "address_2": "SUITE D",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479056655",
            "telephone_number": "765-449-7984",
            "fax_number": "765-449-9791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3738 LANDMARK DR.",
            "address_2": "SUITE D",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479056655",
            "telephone_number": "765-449-7984",
            "fax_number": "765-449-9791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT RADIOLOGY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2013-01-25",
        "status": "A",
        "authorized_official_last_name": "TUCKMAN",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "765-449-7984",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200020370B",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "31714000",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "64882822",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.