Healthcare Provider Details

I. General information

NPI: 1740725100
Provider Name (Legal Business Name): SUMMERTON PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 MAIN ST
SUMMERTON SC
29148
US

IV. Provider business mailing address

PO BOX 69 123 MAIN ST
SUMMERTON SC
29148-0069
US

V. Phone/Fax

Practice location:
  • Phone: 803-488-8888
  • Fax: 803-488-0111
Mailing address:
  • Phone: 803-488-8888
  • Fax: 803-488-0111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN174
License Number StateSC

VIII. Authorized Official

Name: DALE S BARWICK
Title or Position: ANP
Credential: ANP
Phone: 803-488-8888