Provider Demographics
NPI:1043457617
Name:SUMNER ANESTHESIA LLC
Entity type:Organization
Organization Name:SUMNER ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOEDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-221-6182
Mailing Address - Street 1:709 E 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-3716
Mailing Address - Country:US
Mailing Address - Phone:620-221-6182
Mailing Address - Fax:620-221-2948
Practice Address - Street 1:709 E 11TH AVE
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-3716
Practice Address - Country:US
Practice Address - Phone:620-221-6182
Practice Address - Fax:620-221-2948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1467033092367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty