| Colonial Family Practice, Llc | |
|
698 Bultman Dr Suite A Sumter SC 29150 | |
| (803) 773-5227 | |
| (803) 753-9312 |
| Full Name | Colonial Family Practice, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 698 Bultman Dr, Sumter, South Carolina |
| Authorized Official Name and Position | Stephanie K Disher (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 8037735227 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Colonial Family Practice, Llc 325 Broad St Suite 100 Sumter SC 29150-4167 Ph: (803) 773-5227 | Colonial Family Practice, Llc 698 Bultman Dr Suite A Sumter SC 29150 Ph: (803) 773-5227 |
| NPI Number | 1497178131 |
|---|---|
| Provider Enumeration Date | 01/31/2014 |
| Last Update Date | 12/15/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497178131 | NPI | - | NPPES |
| GP3564 | Medicaid | SC | |
| 42D2126583 | Other | SC | CLIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 17676 (South Carolina) | Primary |
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