1912104068 NPI number — SUMNER SURGICAL ASSOCIATES PLLC

Table of content: DENISSE ALEJANDRA TOPETE CARRILLO (NPI 1124676390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912104068 NPI number — SUMNER SURGICAL ASSOCIATES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMNER SURGICAL ASSOCIATES PLLC
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:
1912104068
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
323 STEAM PLANT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALLATIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37066-3025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-452-1060
Provider Business Mailing Address Fax Number:
615-452-5474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
323 STEAM PLANT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALLATIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37066-3025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-452-1060
Provider Business Practice Location Address Fax Number:
615-452-5474
Provider Enumeration Date:
07/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MEWBOURNE
Authorized Official First Name:
RODNEY
Authorized Official Middle Name:
BRANDON
Authorized Official Title or Position:
OWNER - PROVIDER
Authorized Official Telephone Number:
615-452-1060

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , 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: 5441900 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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