Provider Demographics
NPI:1801818661
Name:SUMNER COMMUNITY CLUB
Entity Type:Organization
Organization Name:SUMNER COMMUNITY CLUB
Other - Org Name:COMMUNITY MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:EVERDING
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:563-578-3275
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:IA
Mailing Address - Zip Code:50674-0148
Mailing Address - Country:US
Mailing Address - Phone:563-578-5375
Mailing Address - Fax:563-578-5437
Practice Address - Street 1:909 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:IA
Practice Address - Zip Code:50674-1203
Practice Address - Country:US
Practice Address - Phone:563-578-5375
Practice Address - Fax:563-578-5437
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMNER COMMUNITY CLUB
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-24
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI14492Medicare ID - Type UnspecifiedPROFESSIONAL GROUP
IA70073Medicare ID - Type UnspecifiedMEDICAL CLINIC