Provider Demographics
NPI:1811033822
Name:SUMTER INTERVENTIONAL PAIN ASSOCIATES
Entity Type:Organization
Organization Name:SUMTER INTERVENTIONAL PAIN ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:KAMRAN
Authorized Official - Middle Name:Z
Authorized Official - Last Name:KORANLOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-774-2570
Mailing Address - Street 1:764 W LIBERTY ST
Mailing Address - Street 2:STE 3
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4770
Mailing Address - Country:US
Mailing Address - Phone:803-774-2570
Mailing Address - Fax:803-774-2571
Practice Address - Street 1:764 W LIBERTY ST
Practice Address - Street 2:STE 3
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4770
Practice Address - Country:US
Practice Address - Phone:803-774-2570
Practice Address - Fax:803-774-2571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23150207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC231500Medicaid
SCH69217Medicare UPIN
SC231500Medicaid