Provider Demographics
NPI:1831646017
Name:SUMNER MEDICAL GROUP, PLLC
Entity Type:Organization
Organization Name:SUMNER MEDICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-989-4324
Mailing Address - Street 1:300 STEAM PLANT RD STE 300
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-3089
Mailing Address - Country:US
Mailing Address - Phone:615-230-8070
Mailing Address - Fax:
Practice Address - Street 1:179 HANCOCK ST
Practice Address - Street 2:402
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-6346
Practice Address - Country:US
Practice Address - Phone:615-452-5943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMNER MEDICAL GROUP - LW, PLCC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-06
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care