1366442295 NPI number — SUMNER COMMUNITY CLUB

Table of content: (NPI 1366442295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366442295 NPI number — SUMNER COMMUNITY CLUB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMNER COMMUNITY CLUB
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMMUNITY MEMORIAL HOSPITAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366442295
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 148
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUMNER
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50674-0148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-578-3275
Provider Business Mailing Address Fax Number:
563-578-3279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
909 W 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMNER
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50674-1203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-578-3275
Provider Business Practice Location Address Fax Number:
563-578-3279
Provider Enumeration Date:
07/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
EVERDING
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
DIANE
Authorized Official Title or Position:
CHIEF ADMINISTRATOR/CFO
Authorized Official Telephone Number:
563-578-3275

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 66138 . This is a "BLUE CROSS (SWING BED)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6230725 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0601385 . This is a "TITLE XIX" identifier . This identifiers is of the category "OTHER".
  • Identifier: A5067404 . This is a "JOHN DEERE" identifier . This identifiers is of the category "OTHER".




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