MEDICARE: SUMTER FAMILY HEALTH CENTER - ADMINISTRATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)		SC

General Provider Information

NPI Number	:	1588056741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMTER FAMILY HEALTH CENTER - ADMINISTRATION

Provider Business Mailing Address
First Line	:	219 N WASHINGTON STREET
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29150-4204
Country	:	US
Telephone Number	:	803-774-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	219 N WASHINGTON STREET
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29150-4204
Country	:	US
Telephone Number	:	803-774-4500
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANNIE BROWN
Credential	:
Telephone Number	:	803-774-4500

Provider Enumeration Date	:	02/25/2015
Last Update Date	:	02/25/2015

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