Basic Information
| Provider Information | |||||||||
| NPI: | 1467480046 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUMTER ORTHOPAEDIC ASSOCIATES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N SUMTER ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SUMTER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291504916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037747621 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 N SUMTER ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SUMTER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291504975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037747621 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 06/10/2008 | ||||||||
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| AuthorizedOfficialLastName: | LUEBBERT | ||||||||
| AuthorizedOfficialFirstName: | CATHERINE | ||||||||
| AuthorizedOfficialMiddleName: | ELIZABETH | ||||||||
| AuthorizedOfficialTitleorPosition: | COO/ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8037785290 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TUOMEY PROFESSIONAL SERVICES, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | GP4357 | 05 | SC | MEDICAID |