1295089928 NPI number — MUNFORD MEDICAL CARE SERVICES MMCS LLC

Table of content: (NPI 1295089928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295089928 NPI number — MUNFORD MEDICAL CARE SERVICES MMCS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MUNFORD MEDICAL CARE SERVICES MMCS LLC
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:
MMCS
Provider Other Organization Name Type Code:
5
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:
1295089928
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4150 COBBLESTONE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUMTER
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29154-8043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-439-8643
Provider Business Mailing Address Fax Number:
803-494-2166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
259 BROAD ST STE A
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:
29150-4146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-439-8643
Provider Business Practice Location Address Fax Number:
803-494-2166
Provider Enumeration Date:
11/02/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MUNFORD
Authorized Official First Name:
LORELI
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
803-439-8643

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  28414 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 28414 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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