Provider Demographics
NPI:1154660090
Name:CARDIOLOGY ASSOCIATES OF SUMTER LLC
Entity Type:Organization
Organization Name:CARDIOLOGY ASSOCIATES OF SUMTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-773-1379
Mailing Address - Street 1:213 W HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4911
Mailing Address - Country:US
Mailing Address - Phone:803-773-1379
Mailing Address - Fax:803-775-5161
Practice Address - Street 1:213 W HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4911
Practice Address - Country:US
Practice Address - Phone:803-773-1379
Practice Address - Fax:803-775-5161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19357207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC193579Medicaid
SC193579Medicaid