Provider Demographics
NPI:1912104068
Name:SUMNER SURGICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:SUMNER SURGICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:MEWBOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-452-1060
Mailing Address - Street 1:323 STEAM PLANT RD
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-3025
Mailing Address - Country:US
Mailing Address - Phone:615-452-1060
Mailing Address - Fax:615-452-5474
Practice Address - Street 1:323 STEAM PLANT RD
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3025
Practice Address - Country:US
Practice Address - Phone:615-452-1060
Practice Address - Fax:615-452-5474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5441900Medicaid
3370097Medicare PIN