Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 370 S Pike W, Sumter, South Carolina |
Authorized Official Name and Position | Annie Brown (CHIEF EXECUTICE OFFICER) |
Authorized Official Contact | 8037744500 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
370 S Pike W Sumter SC 29150-2664 Ph: (803) 774-4500 | 370 S Pike W Sumter SC 29150 Ph: (803) 774-4500 |
NPI Number | 1740641919 |
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Provider Enumeration Date | 03/15/2016 |
Last Update Date | 10/14/2019 |
Medicare PECOS PAC ID | 3870575855 |
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Medicare Enrollment ID | O20181126003480 |
Identifier | Type | State | Issuer |
---|---|---|---|
1740641919 | NPI | - | NPPES |
FQC048 | Other | SC | MEDICAID |
7124 | Other | SC | MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (South Carolina) | Primary |
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