Provider Demographics
NPI:1902846595
Name:SUMTER FAMILY MEDICINE ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:SUMTER FAMILY MEDICINE ASSOCIATES, P.A.
Other - Org Name:SUMTER FAMILY MEDICINE, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, P.A.
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROPER
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-775-6374
Mailing Address - Street 1:738 W LIBERTY ST STE A
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4745
Mailing Address - Country:US
Mailing Address - Phone:803-775-6374
Mailing Address - Fax:
Practice Address - Street 1:738 W LIBERTY ST STE A
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4745
Practice Address - Country:US
Practice Address - Phone:803-775-6374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0254Medicaid
SCGP0254Medicaid