Healthcare Provider Details

I. General information

NPI: 1902367626
Provider Name (Legal Business Name): SUMNER COMMUNITY HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 N A ST
WELLINGTON KS
67152-4350
US

IV. Provider business mailing address

1323 N A ST
WELLINGTON KS
67152-4350
US

V. Phone/Fax

Practice location:
  • Phone: 620-326-7451
  • Fax: 620-399-1223
Mailing address:
  • Phone: 620-326-7451
  • Fax: 620-399-1223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DARREL MORRIS
Title or Position: COO
Credential:
Phone: 918-527-1234