Healthcare Provider Details

I. General information

NPI: 1801818661
Provider Name (Legal Business Name): SUMNER COMMUNITY CLUB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 W 1ST ST
SUMNER IA
50674-1203
US

IV. Provider business mailing address

PO BOX 148
SUMNER IA
50674-0148
US

V. Phone/Fax

Practice location:
  • Phone: 563-578-5375
  • Fax: 563-578-5437
Mailing address:
  • Phone: 563-578-5375
  • Fax: 563-578-5437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DAWN DIANE EVERDING
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CFO
Phone: 563-578-3275