Provider Demographics
NPI:1467480046
Name:SUMTER ORTHOPAEDIC ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SUMTER ORTHOPAEDIC ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LUEBBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-778-5290
Mailing Address - Street 1:100 N SUMTER ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4916
Mailing Address - Country:US
Mailing Address - Phone:803-774-7621
Mailing Address - Fax:
Practice Address - Street 1:100 N SUMTER ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4975
Practice Address - Country:US
Practice Address - Phone:803-774-7621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TUOMEY PROFESSIONAL SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-30
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4357Medicaid
SC5946840001Medicare NSC
SCGP4357Medicaid