Provider Demographics
NPI:1336269638
Name:SUMNER COUNTY FAMILY CARE CENTER, PA
Entity Type:Organization
Organization Name:SUMNER COUNTY FAMILY CARE CENTER, PA
Other - Org Name:MULVANE FAMILY CARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
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 1:102 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MULVANE
Mailing Address - State:KS
Mailing Address - Zip Code:67110-1751
Mailing Address - Country:US
Mailing Address - Phone:316-777-0106
Mailing Address - Fax:316-777-4300
Practice Address - Street 1:102 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MULVANE
Practice Address - State:KS
Practice Address - Zip Code:67110-1751
Practice Address - Country:US
Practice Address - Phone:316-777-0106
Practice Address - Fax:316-777-4300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS604OtherBCBS