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General NPI Number Information
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NPI Number | 1699071746
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Entity Type | Organization
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Legal Business Name | SUMTER GASTROENTEROLOGY
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Dates
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Enumeration Date | 02/08/2011
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Last Update Date | 12/29/2022
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Provider Practice Location Address
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Address Line | 641 W WESMARK BLVD
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City | SUMTER
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State | SC
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Zip | 29150-1900
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Country | US
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Telephone | 803-905-6944
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Fax | 803-469-3944
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Provider Business Mailing Address
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Address Line | 641 W WESMARK BLVD
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City | SUMTER
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State | SC
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Zip | 29150-1900
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Country | US
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Telephone | 803-905-6944
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Fax | 803-469-3944
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | MEG KWIECINSKI
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Credential |
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Telephone | 803-905-6944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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