Provider Demographics
NPI:1689707275
Name:SUMNER COUNTY HOSPITAL DISTRICT NO 1
Entity Type:Organization
Organization Name:SUMNER COUNTY HOSPITAL DISTRICT NO 1
Other - Org Name:CALDWELL REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-845-6492
Mailing Address - Street 1:761 W 175TH ST S
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:KS
Mailing Address - Zip Code:67022-8301
Mailing Address - Country:US
Mailing Address - Phone:620-845-6492
Mailing Address - Fax:620-845-6475
Practice Address - Street 1:761 W 175TH ST S
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:KS
Practice Address - Zip Code:67022-8301
Practice Address - Country:US
Practice Address - Phone:620-845-6492
Practice Address - Fax:620-845-6475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH-096-001275N00000X
KSH096001282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS17Z329Medicare Oscar/Certification