Provider Demographics
NPI:1538120506
Name:SUMNER MEDICAL CLINIC PC
Entity Type:Organization
Organization Name:SUMNER MEDICAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICICAN
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PAT
Authorized Official - Last Name:ROSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:563-578-3244
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:IA
Mailing Address - Zip Code:50674-0268
Mailing Address - Country:US
Mailing Address - Phone:563-578-3244
Mailing Address - Fax:563-578-3247
Practice Address - Street 1:909 W 1 ST
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:IA
Practice Address - Zip Code:50674
Practice Address - Country:US
Practice Address - Phone:563-578-3244
Practice Address - Fax:563-578-3247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-30
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2054207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0638791Medicaid
IA0638791Medicaid
IA163879Medicare Oscar/Certification
IAI7736Medicare PIN