Basic Information
| Provider Information | |||||||||
| NPI: | 1831646017 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUMNER MEDICAL GROUP, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 STEAM PLANT RD STE 300 | ||||||||
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| City: | GALLATIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370663089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152308070 | ||||||||
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| Practice Location | |||||||||
| Address1: | 179 HANCOCK ST | ||||||||
| Address2: | 402 | ||||||||
| City: | GALLATIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370666346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154525943 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2016 | ||||||||
| LastUpdateDate: | 09/07/2016 | ||||||||
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| AuthorizedOfficialLastName: | BOLSTAD | ||||||||
| AuthorizedOfficialFirstName: | JANET | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6159894324 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SUMNER MEDICAL GROUP - LW, PLCC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.