Provider Demographics
NPI:1952012098
Name:SWEETENBURG, COREY
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:SWEETENBURG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 RED HILL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CASSATT
Mailing Address - State:SC
Mailing Address - Zip Code:29032-9218
Mailing Address - Country:US
Mailing Address - Phone:803-549-4946
Mailing Address - Fax:803-888-2736
Practice Address - Street 1:1236 WILSON HALL RD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2903
Practice Address - Country:US
Practice Address - Phone:803-549-4946
Practice Address - Fax:803-888-2736
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)