Provider Demographics
NPI:1518033083
Name:TERESA L BUSCHER MD
Entity Type:Organization
Organization Name:TERESA L BUSCHER MD
Other - Org Name:SUMTER PEDIATRICS PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST VP
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-775-3813
Mailing Address - Street 1:POC MANAGEMENT GROUP LLC
Mailing Address - Street 2:300 W WARNER AVE
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:237 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4202
Practice Address - Country:US
Practice Address - Phone:803-775-3813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC21022332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC210220Medicaid
4226660OtherOTHER ID NUMBER-COMMERCIAL NUMBER