1083697999 NPI number — SUMNER HOMECARE PHARMACY LLC

Table of content: (NPI 1083697999)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083697999 NPI number — SUMNER HOMECARE PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMNER HOMECARE PHARMACY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083697999
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 CUMBERLAND BND
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37228-1804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-312-9880
Provider Business Mailing Address Fax Number:
615-320-5418

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 STEAM PLANT RD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
GALLATIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37066-3032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-230-3122
Provider Business Practice Location Address Fax Number:
615-230-3124
Provider Enumeration Date:
11/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TOMPKINS
Authorized Official First Name:
FLORIS
Authorized Official Middle Name:
H
Authorized Official Title or Position:
EXEC VP METRO MEDICAL PARTNERS INC
Authorized Official Telephone Number:
615-312-9880

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  408 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3540638 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4431108 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".




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