Organization
SUMNER R CULLOM M D P A
Active
Other names
Cullom Rural Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUMNER R CULLOM M.D. (OWNER)
(870) 563-6512
Entity
Organization
Contact information
Practice address
700 W KEISER AVE, OSCEOLA, AR 72370-3506
(870) 563-6512
(870) 563-5013
Mailing address
700 W KEISER AVE, OSCEOLA, AR 72370-3500
(870) 563-6512
(870) 563-5013
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
C4583
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5C697
MEDICARE PTAN
—
Enumeration date
05/16/2007
Last updated
04/14/2010
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