Provider Demographics
NPI:1821155904
Name:SUMTER FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:SUMTER FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:W
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:803-774-4500
Mailing Address - Street 1:1278 N LAFAYETTE DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-2964
Mailing Address - Country:US
Mailing Address - Phone:803-774-4500
Mailing Address - Fax:803-774-4627
Practice Address - Street 1:1278 N LAFAYETTE DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2964
Practice Address - Country:US
Practice Address - Phone:803-774-4500
Practice Address - Fax:803-774-4627
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMTER FAMILY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-02
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN 3096261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health