Provider Demographics
NPI:1780819235
Name:PHOEBE SUMTER MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:PHOEBE SUMTER MEDICAL CENTER, INC.
Other - Org Name:PHOEBE SUMTER HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. V.P. / CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOUDERMILK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-312-4068
Mailing Address - Street 1:1048 E FORSYTH ST
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3722
Mailing Address - Country:US
Mailing Address - Phone:229-931-1280
Mailing Address - Fax:229-924-1014
Practice Address - Street 1:126 E FURLOW ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-4027
Practice Address - Country:US
Practice Address - Phone:229-928-4000
Practice Address - Fax:229-928-1322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000629725AMedicaid
GA000629725AMedicaid