Basic Information
| Provider Information | |||||||||
| NPI: | 1679578223 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUMNER REGIONAL MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1323 N. A. STREET | ||||||||
| Address2: | |||||||||
| City: | WELLINGTON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 671524350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203267451 | ||||||||
| FaxNumber: | 6203262225 | ||||||||
| Practice Location | |||||||||
| Address1: | 1323 N. A. STREET | ||||||||
| Address2: | |||||||||
| City: | WELLINGTON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 671524350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203267451 | ||||||||
| FaxNumber: | 6203262225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2005 | ||||||||
| LastUpdateDate: | 11/08/2012 | ||||||||
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| AuthorizedOfficialLastName: | WEAVER | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6203267451 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SUMNER REGIONAL MEDICAL CENTER | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | H096002 | KS | N | Hospitals | General Acute Care Hospital | 282N00000X | H-096-002 | KS | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 000078 | 01 | KS | BCBS IN/OUT PATIENT FAC | OTHER | 100088990A | 05 | KS | MEDICAID |