MEDICARE: SUMTER MEDICAL CONSULTANTS

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	207RG0100X	Gastroenterology Physician	8318	SC
2	207RP1001X	Pulmonary Disease Physician	9195	SC
3	207RC0000X	Cardiovascular Disease Physician	7862	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	C30400	OTHER	SC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649201658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMTER MEDICAL CONSULTANTS

Provider Business Mailing Address
First Line	:	540 PHYSICIANS LN
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29150-3370
Country	:	US
Telephone Number	:	803-778-1941
Fax Number	:	803-938-9513

Provider Business Practice Location Address
First Line	:	540 PHYSICIANS LN
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29150-3370
Country	:	US
Telephone Number	:	803-778-1941
Fax Number	:	803-938-9513

Authorized Official
Title or Position	:	SECRETARY
Name	:	DR. WILLIAM STRAT STAVROU
Credential	:	M.D.
Telephone Number	:	803-778-1941

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	02/07/2008

Similar Medicare Providers

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Practice Location Address:

540 PHYSICIANS LN
SUMTER, SC
29150-3370

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Practice Fax:

1013960616 — DR. LISBETH W POAG DMD
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1255386447 — DR. SHARLENE MARTIN DMD
Practice Location Address:

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SUMTER, SC
29150-3370

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1528112398 — CAROLINA CHILDREN'S DENTISTRY, LLC
Practice Location Address:

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SUMTER, SC
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1578865564 — MCLEOD PHYSICIAN ASSOCIATES II
Practice Location Address:

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29150-3370

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1871882373 — SUMTER PULMONARY CONSULTANTS LLC
Practice Location Address:

540 PHYSICIANS LN
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29150-3370

Practice Phone: 803-778-1941
Practice Fax:

Directions to “SUMTER MEDICAL CONSULTANTS ” Practice Location

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