Provider Demographics
NPI:1437283991
Name:SUMNER COUNTY FAMILY CARE CENTER PA
Entity Type:Organization
Organization Name:SUMNER COUNTY FAMILY CARE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-326-3301
Mailing Address - Street 1:507 E 16TH ST
Mailing Address - Street 2:STE 1
Mailing Address - City:WELLINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67152-2828
Mailing Address - Country:US
Mailing Address - Phone:620-326-3301
Mailing Address - Fax:620-326-7086
Practice Address - Street 1:507 E 16TH ST
Practice Address - Street 2:STE 1
Practice Address - City:WELLINGTON
Practice Address - State:KS
Practice Address - Zip Code:67152-2828
Practice Address - Country:US
Practice Address - Phone:620-326-3301
Practice Address - Fax:620-326-7086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS173819261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100088130AMedicaid
KS100088130DMedicaid
KS3840OtherBCBS CLINIC NUMBER
CS5682OtherRAILROAD MEDICARE
CS5682OtherRAILROAD MEDICARE
KS173819Medicare ID - Type UnspecifiedRHC CLINIC NUMBER
KS100088130AMedicaid