Basic Information
Provider Information | |||||||||
NPI: | 1164812038 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | D. DUNCAN SUMPTER, P.C. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | APPALACHIAN COMMUNITY SERVICES, INC | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 750 W US HIGHWAY 64 | ||||||||
Address2: |   | ||||||||
City: | MURPHY | ||||||||
State: | NC | ||||||||
PostalCode: | 289068115 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8288370071 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 19645 US HWY 19 | ||||||||
Address2: |   | ||||||||
City: | ANDREWS | ||||||||
State: | NC | ||||||||
PostalCode: | 289019259 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8288370071 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/30/2015 | ||||||||
LastUpdateDate: | 01/30/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | LANCE | ||||||||
AuthorizedOfficialFirstName: | DEB | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | MEDICAL RECORDS MANAGER | ||||||||
AuthorizedOfficialTelephone: | 8288370071 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320900000X |   |   | N |   | Residential Treatment Facilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |   | 251S00000X |   |   | Y |   | Agencies | Community/Behavioral Health |   |
ID Information
ID | Type | State | Issuer | Description | 6410054 | 05 | NC |   | MEDICAID |