Provider Demographics
NPI:1487719076
Name:SUMTER REGIONAL HOSPITAL
Entity type:Organization
Organization Name:SUMTER REGIONAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARYANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:N P
Authorized Official - Phone:229-937-5321
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:ELLAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31806-0065
Mailing Address - Country:US
Mailing Address - Phone:229-937-5321
Mailing Address - Fax:229-937-2232
Practice Address - Street 1:72 S. BROAD ST.
Practice Address - Street 2:
Practice Address - City:ELLAVILLE
Practice Address - State:GA
Practice Address - Zip Code:31806
Practice Address - Country:US
Practice Address - Phone:229-937-5321
Practice Address - Fax:229-937-2232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00000019FMedicaid
GA00000019FMedicaid