Provider Demographics
NPI:1609103530
Name:SUMTER PLASTIC AND RECONSTRUCTIVE SURGERY, LLC
Entity Type:Organization
Organization Name:SUMTER PLASTIC AND RECONSTRUCTIVE SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/COLLECTIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:DABBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-774-5279
Mailing Address - Street 1:115 N SUMTER ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4972
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 N SUMTER ST
Practice Address - Street 2:SUITE 115
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4972
Practice Address - Country:US
Practice Address - Phone:803-774-5279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TUOMEY PROFESSIONAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL32263208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty