Elijah Scott Bausum, AGNP-C | |
1285 Wilson Hall Rd, Sumter, SC 29150-1804 | |
(803) 905-3555 | |
Not Available |
Full Name | Elijah Scott Bausum |
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Gender | Male |
Speciality | Urology |
Location | 1285 Wilson Hall Rd, Sumter, South Carolina |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1801642707 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208800000X | Urology | 28689 (South Carolina) | Primary |
Entity Name | Urology Clinic, Inc. |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1912368457 PECOS PAC ID: 2860781556 Enrollment ID: O20160519001178 |
Mailing Address | Practice Location Address |
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Elijah Scott Bausum, AGNP-C 704 Haile St, Sumter, SC 29150-3144 Ph: (803) 464-2698 | Elijah Scott Bausum, AGNP-C 1285 Wilson Hall Rd, Sumter, SC 29150-1804 Ph: (803) 905-3555 |
Jesse Caleb Rockmore, DO Urology Medicare: Medicare Enrolled Practice Location: 1285 Wilson Hall Rd, Sumter, SC 29150 Phone: 803-905-3555 Fax: 803-905-3570 | |
Brittney Hawkins, APRN Urology Medicare: Accepting Medicare Assignments Practice Location: 1285 Wilson Hall Rd, Sumter, SC 29150 Phone: 803-905-3555 Fax: 803-905-3570 | |
Dr. Charles Moss, M.D. Urology Medicare: Not Enrolled in Medicare Practice Location: 410 W Wesmark Blvd, Sumter, SC 29150 Phone: 803-469-4402 Fax: 803-469-4473 | |
Dr. Vijay Paul Pinto, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 1285 Wilson Hall Road, Sumter, SC 29150 Phone: 803-905-3555 Fax: 803-905-3570 |