Healthcare Provider Details

I. General information

NPI: 1871230870
Provider Name (Legal Business Name): MSC & Z
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 BROAD ST STE B
SUMTER SC
29150-4146
US

IV. Provider business mailing address

259 BROAD ST STE B
SUMTER SC
29150-4146
US

V. Phone/Fax

Practice location:
  • Phone: 803-774-3777
  • Fax: 803-774-3780
Mailing address:
  • Phone: 803-774-3777
  • Fax: 803-774-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELIZABETH MARIE DISHER
Title or Position: OWNER
Credential: PGC, APRN, FNP
Phone: 803-840-4772