Healthcare Provider Details

I. General information

NPI: 1295089928
Provider Name (Legal Business Name): MUNFORD MEDICAL CARE SERVICES MMCS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 BROAD ST STE A
SUMTER SC
29150-4146
US

IV. Provider business mailing address

4150 COBBLESTONE RD
SUMTER SC
29154-8043
US

V. Phone/Fax

Practice location:
  • Phone: 803-439-8643
  • Fax: 803-494-2166
Mailing address:
  • Phone: 803-439-8643
  • Fax: 803-494-2166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number28414
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28414
License Number StateSC

VIII. Authorized Official

Name: DR. LORELI MUNFORD
Title or Position: OWNER
Credential: MD
Phone: 803-439-8643