Provider Demographics
NPI:1699071746
Name:SUMTER GASTROENTEROLOGY
Entity type:Organization
Organization Name:SUMTER GASTROENTEROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEG
Authorized Official - Middle Name:
Authorized Official - Last Name:KWIECINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-905-6944
Mailing Address - Street 1:641 W WESMARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1900
Mailing Address - Country:US
Mailing Address - Phone:803-905-6944
Mailing Address - Fax:803-469-3944
Practice Address - Street 1:641 W WESMARK BLVD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1900
Practice Address - Country:US
Practice Address - Phone:803-905-6944
Practice Address - Fax:803-469-3944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP5689Medicaid