Provider Demographics
NPI:1871593749
Name:SUMTER PEDIATRICS, P.A.
Entity type:Organization
Organization Name:SUMTER PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-775-6311
Mailing Address - Street 1:237 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4202
Mailing Address - Country:US
Mailing Address - Phone:803-775-6311
Mailing Address - Fax:803-778-5131
Practice Address - Street 1:237 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4202
Practice Address - Country:US
Practice Address - Phone:803-775-6311
Practice Address - Fax:803-778-5131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA1051Medicaid
SCPA1051Medicaid