Provider Demographics
NPI:1366442295
Name:SUMNER COMMUNITY CLUB
Entity type:Organization
Organization Name:SUMNER COMMUNITY CLUB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATOR/CFO
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:563-578-3275
Mailing Address - Fax:563-578-3279
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:563-578-3275
Practice Address - Fax:563-578-3279
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMNER COMMUNITY CLUB
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-21
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
66138OtherBLUE CROSS (SWING BED)
6230725OtherAETNA
0601385OtherTITLE XIX
A5067404OtherJOHN DEERE
66138OtherBLUE CROSS (SWING BED)
A5067404OtherJOHN DEERE