Provider Demographics
NPI:1073685996
Name:SUMTER REGIONAL MEDICAL GROUP, PC
Entity Type:Organization
Organization Name:SUMTER REGIONAL MEDICAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CBO DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-928-4144
Mailing Address - Street 1:120 HIGHWAY 19 NORTH
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709
Mailing Address - Country:US
Mailing Address - Phone:229-928-4144
Mailing Address - Fax:
Practice Address - Street 1:120 HIGHWAY 19 NORTH
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709
Practice Address - Country:US
Practice Address - Phone:229-928-4144
Practice Address - Fax:229-928-3410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty