Healthcare Provider Details

I. General information

NPI: 1649201658
Provider Name (Legal Business Name): SUMTER MEDICAL CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 PHYSICIANS LN
SUMTER SC
29150-3370
US

IV. Provider business mailing address

540 PHYSICIANS LN
SUMTER SC
29150-3370
US

V. Phone/Fax

Practice location:
  • Phone: 803-778-1941
  • Fax: 803-938-9513
Mailing address:
  • Phone: 803-778-1941
  • Fax: 803-938-9513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number7862
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number8318
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number9195
License Number StateSC

VIII. Authorized Official

Name: DR. WILLIAM STRAT STAVROU
Title or Position: SECRETARY
Credential: M.D.
Phone: 803-778-1941