Provider Demographics
NPI:1871544130
Name:SONYA C SIMS
Entity type:Organization
Organization Name:SONYA C SIMS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-672-6881
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:128 N MAPLE STREET
Mailing Address - City:PAGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29728
Mailing Address - Country:US
Mailing Address - Phone:843-672-6881
Mailing Address - Fax:843-672-9576
Practice Address - Street 1:128 N MAPLE STREET
Practice Address - Street 2:
Practice Address - City:PAGELAND
Practice Address - State:SC
Practice Address - Zip Code:29728
Practice Address - Country:US
Practice Address - Phone:843-672-6881
Practice Address - Fax:843-672-9576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703690Medicaid
SCDE2005Medicaid
SC4268770001Medicare NSC
SCDE2005Medicaid