Organization Name: | SUMTER SPECIALTY MEDICINE |
NPI Number: | 1265742076 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROBERT LAGESSE (SR VP PHYSICIAN PRACTICES) |
Mailing Address: | 120 Highway 280 W Americus |
State: | GA US |
Postal Code: | 317198645 |
Phone Number: | 2299311159 |
Fax Number: | 2299311160 |
NPI Enumeration Date: | 10/14/2010 |
NPI Last Update Date: | 10/14/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Multi-Specialty |
Taxonomy Definition: |