MEDICARE: SUMTER PODIATRY SERVICES PA

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	213E00000X	Podiatrist	PDO886	SC

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	:	1861520157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMTER PODIATRY SERVICES PA

Provider Business Mailing Address
First Line	:	PO BOX 1485
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29151-1485
Country	:	US
Telephone Number	:	803-469-9255
Fax Number	:	803-469-9253

Provider Business Practice Location Address
First Line	:	2620 HARDEE CV
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29150-1893
Country	:	US
Telephone Number	:	803-469-9255
Fax Number	:	803-469-9253

Authorized Official
Title or Position	:	PRESIDENT PODIATRIST
Name	:	DR. EMANUEL WILLIS
Credential	:	DPM
Telephone Number	:	803-469-9255

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	10/06/2011

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Directions to “SUMTER PODIATRY SERVICES PA ” Practice Location

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