1659401198 NPI number — JOANNIE R SUMMERS CRNA

Table of content: JOANNIE R SUMMERS CRNA (NPI 1659401198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659401198 NPI number — JOANNIE R SUMMERS CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUMMERS
Provider First Name:
JOANNIE
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

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:
1659401198
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1547
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEDALIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65302-1547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-826-5960
Provider Business Mailing Address Fax Number:
660-826-4852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3310 ASPEN GROVE DR STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37067-2852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-430-0364
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  11432 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: 118730 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3635427 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009933779 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4114044 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4222379 . This is a "BLUE CROSS/BLUE SHIELD OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 74010349 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00737377 . This is a "RR MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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