Provider Demographics
NPI:1417120270
Name:MARK S. SUMIDA, MD, PC
Entity Type:Organization
Organization Name:MARK S. SUMIDA, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMIDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:423-877-4705
Mailing Address - Street 1:1724 HAMILL ROAD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343
Mailing Address - Country:US
Mailing Address - Phone:423-877-4705
Mailing Address - Fax:423-877-9970
Practice Address - Street 1:1724 HAMILL ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343
Practice Address - Country:US
Practice Address - Phone:423-877-4705
Practice Address - Fax:423-877-9970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20177207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4707230001Medicare NSC
3374085Medicare PIN