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General NPI Number Information
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NPI Number | 1740725100
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Entity Type | Organization
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Legal Business Name | SUMMERTON PRIMARY CARE
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Dates
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Enumeration Date | 12/21/2016
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 123 MAIN ST
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City | SUMMERTON
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State | SC
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Zip | 29148
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Country | US
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Telephone | 803-488-8888
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Fax | 803-488-0111
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Provider Business Mailing Address
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Address Line | PO BOX 69 123 MAIN ST
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City | SUMMERTON
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State | SC
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Zip | 29148-0069
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Country | US
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Telephone | 803-488-8888
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Fax | 803-488-0111
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Authorized Official
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Title or Position | ANP
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Name | DALE S BARWICK
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Credential | ANP
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Telephone | 803-488-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APN174
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License Number State | SC
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