Provider Demographics
NPI:1295089928
Name:MUNFORD MEDICAL CARE SERVICES MMCS LLC
Entity type:Organization
Organization Name:MUNFORD MEDICAL CARE SERVICES MMCS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORELI
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-439-8643
Mailing Address - Street 1:4150 COBBLESTONE RD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-8043
Mailing Address - Country:US
Mailing Address - Phone:803-439-8643
Mailing Address - Fax:803-494-2166
Practice Address - Street 1:259 BROAD ST STE A
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4146
Practice Address - Country:US
Practice Address - Phone:803-439-8643
Practice Address - Fax:803-494-2166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-02
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28414208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty