1518033083 NPI number — TERESA L BUSCHER MD

Table of content: (NPI 1518033083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518033083 NPI number — TERESA L BUSCHER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TERESA L BUSCHER MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SUMTER PEDIATRICS PA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518033083
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
POC MANAGEMENT GROUP LLC
Provider Second Line Business Mailing Address:
300 W WARNER AVE
Provider Business Mailing Address City Name:
SANTA ANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
237 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMTER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29150-4202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-775-3813
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUSCHER
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
Authorized Official Title or Position:
ASST VP
Authorized Official Telephone Number:
803-775-3813

Provider Taxonomy Codes

  • Taxonomy code: 332900000X , with the licence number:  SC21022 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 210220 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4226660 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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