Provider Demographics
NPI:1285679290
Name:SUMTER EAR, NOSE, THROAT & FACIAL PLASTIC SURGERY, LLC
Entity Type:Organization
Organization Name:SUMTER EAR, NOSE, THROAT & FACIAL PLASTIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:LOVICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-778-5970
Mailing Address - Street 1:100 N SUMTER ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4916
Mailing Address - Country:US
Mailing Address - Phone:803-778-5970
Mailing Address - Fax:803-778-5403
Practice Address - Street 1:100 N SUMTER ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4916
Practice Address - Country:US
Practice Address - Phone:803-778-5970
Practice Address - Fax:803-778-5403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2894Medicaid
SCGP2894Medicaid