Healthcare Provider Details

I. General information

NPI: 1124098512
Provider Name (Legal Business Name): WESMARK AMBULATORY SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W WESMARK BLVD
SUMTER SC
29150-1983
US

IV. Provider business mailing address

420 W WESMARK BLVD
SUMTER SC
29150-1983
US

V. Phone/Fax

Practice location:
  • Phone: 803-905-5590
  • Fax: 803-905-5595
Mailing address:
  • Phone: 803-905-5590
  • Fax: 803-905-5595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number05 15999
License Number StateSC

VIII. Authorized Official

Name: DR. ROBERT E LEE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 803-905-5590