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General NPI Number Information
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NPI Number | 1780684548
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Entity Type | Organization
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Legal Business Name | SUMNER COMMUNITY CLUB
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Dates
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Enumeration Date | 07/22/2005
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Last Update Date | 07/31/2015
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Provider Practice Location Address
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Address Line | 909 W 1ST ST
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City | SUMNER
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State | IA
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Zip | 50674-1203
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Country | US
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Telephone | 563-578-3275
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Fax | 563-578-3279
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Provider Business Mailing Address
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Address Line | PO BOX 148
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City | SUMNER
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State | IA
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Zip | 50674-0148
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Country | US
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Telephone | 563-578-3275
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Fax | 563-578-3279
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | DAWN DIANE EVERDING
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Credential | CFO
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Telephone | 563-578-3275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 090086H
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License Number State | IA
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