Basic Information
| Provider Information | |||||||||
| NPI: | 1548731904 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SUMNER REGIONAL MEDICAL CENTER | ||||||||
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| OtherOrganizationName: | SUMMER PRIMARY CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1323 N A ST | ||||||||
| Address2: | |||||||||
| City: | WELLINGTON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 671524350 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1323 N A ST | ||||||||
| Address2: | |||||||||
| City: | WELLINGTON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 671524350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203267451 | ||||||||
| FaxNumber: | 6203991223 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2018 | ||||||||
| LastUpdateDate: | 02/26/2019 | ||||||||
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| AuthorizedOfficialLastName: | LOCKHART | ||||||||
| AuthorizedOfficialFirstName: | SHERRY | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALS | ||||||||
| AuthorizedOfficialTelephone: | 6203267451 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 170039 | 01 | KS | CMS | OTHER |