MEDICARE: SUMTER PULMONARY CONSULTANTS LLC

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	207RP1001X	Pulmonary Disease Physician		SC

General Provider Information

NPI Number	:	1871882373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMTER PULMONARY CONSULTANTS LLC

Provider Business Mailing Address
First Line	:	540 PHYSICIANS LN
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29150-3370
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	540 PHYSICIANS LN
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29150-3370
Country	:	US
Telephone Number	:	803-778-1941
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHARLES H WHITE
Credential	:	MD
Telephone Number	:	803-778-1941

Provider Enumeration Date	:	04/05/2011
Last Update Date	:	07/13/2011

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