Provider Demographics
NPI:1467810937
Name:SUMTER FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:SUMTER FAMILY HEALTH CENTER
Other - Org Name:SUMTER FAMILY HEALTH CENTER - DENTAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-774-4500
Mailing Address - Street 1:1278 N LAFAYETTE DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-2964
Mailing Address - Country:US
Mailing Address - Phone:803-774-4500
Mailing Address - Fax:
Practice Address - Street 1:616 BULTMAN DR
Practice Address - Street 2:SUITE #A
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2593
Practice Address - Country:US
Practice Address - Phone:803-774-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMTER FAMILY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7124OtherMEDICARE
SCFQC048Medicaid