Provider Demographics
NPI:1902367626
Name:SUMNER COMMUNITY HOSPITAL LLC
Entity Type:Organization
Organization Name:SUMNER COMMUNITY HOSPITAL LLC
Other - Org Name:SUMNER PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DARREL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-527-1234
Mailing Address - Street 1:1323 N A ST
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67152-4350
Mailing Address - Country:US
Mailing Address - Phone:620-326-7451
Mailing Address - Fax:620-399-1223
Practice Address - Street 1:1323 N A ST
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:KS
Practice Address - Zip Code:67152-4350
Practice Address - Country:US
Practice Address - Phone:620-326-7451
Practice Address - Fax:620-399-1223
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMNER COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-26
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty