Provider Demographics
NPI:1477647824
Name:SUMTER REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:SUMTER REGIONAL HOSPITAL
Other - Org Name:ELLAVILLE PRIMARY MEDICINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE CFO
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HAMMETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-931-1280
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31719
Mailing Address - Country:US
Mailing Address - Phone:229-924-6011
Mailing Address - Fax:
Practice Address - Street 1:72 S BROAD ST
Practice Address - Street 2:
Practice Address - City:ELLAVILLE
Practice Address - State:GA
Practice Address - Zip Code:31806
Practice Address - Country:US
Practice Address - Phone:229-937-5321
Practice Address - Fax:229-937-2232
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMTER REGIONAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-02
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00000019FMedicaid
GA113403Medicare ID - Type UnspecifiedRURAL CLINIC