MEDICARE: SUMTER REGIONAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487719076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMTER REGIONAL HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 65
Second Line	:
City	:	ELLAVILLE
State	:	GA
Zip	:	31806-0065
Country	:	US
Telephone Number	:	229-937-5321
Fax Number	:	229-937-2232

Provider Business Practice Location Address
First Line	:	72 S. BROAD ST.
Second Line	:
City	:	ELLAVILLE
State	:	GA
Zip	:	31806
Country	:	US
Telephone Number	:	229-937-5321
Fax Number	:	229-937-2232

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. MARYANNE SHEPHERD
Credential	:	N. P.
Telephone Number	:	229-937-5321

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	08/22/2020

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Directions to “SUMTER REGIONAL HOSPITAL ” Practice Location

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