Provider Demographics
NPI:1922310093
Name:SUMNER PHYSICIAN PRACTICES LLC
Entity Type:Organization
Organization Name:SUMNER PHYSICIAN PRACTICES LLC
Other - Org Name:SUMNER STATION FAMILY WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AVP, SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-920-7000
Mailing Address - Street 1:330 SEVEN SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5098
Mailing Address - Country:US
Mailing Address - Phone:615-920-7000
Mailing Address - Fax:
Practice Address - Street 1:225 BIG STATION CAMP BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-8464
Practice Address - Country:US
Practice Address - Phone:615-328-3400
Practice Address - Fax:615-328-3417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1519716Medicaid
TN1519716Medicaid