Provider Demographics
NPI:1962488817
Name:SUMTER PEDIATRICS, P.A.
Entity Type:Organization
Organization Name:SUMTER PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHUMATE
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:803-775-6311
Mailing Address - Street 1:241 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4202
Mailing Address - Country:US
Mailing Address - Phone:803-775-6311
Mailing Address - Fax:803-778-5131
Practice Address - Street 1:241 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4202
Practice Address - Country:US
Practice Address - Phone:803-775-6311
Practice Address - Fax:803-778-5131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7203Medicare ID - Type Unspecified