Provider Demographics
NPI:1053363879
Name:TUOMEY SURGICAL SERVICES LLC
Entity type:Organization
Organization Name:TUOMEY SURGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MISS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LUEBBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-774-5290
Mailing Address - Street 1:129 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4949
Mailing Address - Country:US
Mailing Address - Phone:803-774-9000
Mailing Address - Fax:803-774-5217
Practice Address - Street 1:115 N SUMTER ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4972
Practice Address - Country:US
Practice Address - Phone:803-778-0212
Practice Address - Fax:803-775-7258
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TUOMEY PROFESSIONAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-17
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4094Medicaid
SCGP4094Medicaid