Provider Demographics
NPI:1871557439
Name:SUMTER MEDICAL SUPPLIES INC
Entity type:Organization
Organization Name:SUMTER MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:TALLON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:803-773-8447
Mailing Address - Street 1:32 S MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-5245
Mailing Address - Country:US
Mailing Address - Phone:803-773-8447
Mailing Address - Fax:803-775-0751
Practice Address - Street 1:32 S MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-5245
Practice Address - Country:US
Practice Address - Phone:803-773-8447
Practice Address - Fax:803-775-0751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4656980001Medicare NSC