Provider Demographics
NPI:1588974406
Name:SUMTER WOMEN AND FAMILY HEALTH
Entity type:Organization
Organization Name:SUMTER WOMEN AND FAMILY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP PHYSICIAN PRACTICES
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGESSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-312-1000
Mailing Address - Street 1:122 HIGHWAY 280 W
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31719-8645
Mailing Address - Country:US
Mailing Address - Phone:229-931-1159
Mailing Address - Fax:
Practice Address - Street 1:122 HIGHWAY 280 W
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31719-8645
Practice Address - Country:US
Practice Address - Phone:229-931-1159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHOEBE PHYSICIAN GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty