Provider Demographics
NPI:1306280698
Name:SUMTER NEPHROLOGY LLC
Entity type:Organization
Organization Name:SUMTER NEPHROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:II
Authorized Official - Credentials:DO
Authorized Official - Phone:803-938-5663
Mailing Address - Street 1:115 N SUMTER ST
Mailing Address - Street 2:305
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4972
Mailing Address - Country:US
Mailing Address - Phone:803-938-5663
Mailing Address - Fax:803-339-1984
Practice Address - Street 1:3 MEDICAL CT
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4760
Practice Address - Country:US
Practice Address - Phone:803-938-5663
Practice Address - Fax:803-938-5088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP6300Medicaid
SCGP6300Medicaid