Provider Demographics
NPI:1649201658
Name:SUMTER MEDICAL CONSULTANTS
Entity Type:Organization
Organization Name:SUMTER MEDICAL CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:STRAT
Authorized Official - Last Name:STAVROU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-778-1941
Mailing Address - Street 1:540 PHYSICIANS LN
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-3370
Mailing Address - Country:US
Mailing Address - Phone:803-778-1941
Mailing Address - Fax:803-938-9513
Practice Address - Street 1:540 PHYSICIANS LN
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-3370
Practice Address - Country:US
Practice Address - Phone:803-778-1941
Practice Address - Fax:803-938-9513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7862207RC0000X
SC8318207RG0100X
SC9195207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCMPA974Medicaid
SCC30400OtherRAILROAD MEDICARE
SCC30400OtherRAILROAD MEDICARE