Organization
SUMMERTON FAMILY MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID T. KOON MD (OWNER/PHYSICIAN)
(803) 485-2351
Entity
Organization
Contact information
Practice address
107 MAIN STREET, SUMMERTON, SC 29148
(803) 485-2351
(803) 485-2219
Mailing address
PO BOX 10, SUMMERTON, SC 29148-0010
(803) 485-2351
(803) 485-2219
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CJ8906
MEDICARE ID RETIRED RR
SC
01
—
F891927161
MEDICARE PROVIDER
SC
05
—
GP3257
—
SC
Enumeration date
08/22/2005
Last updated
05/08/2008
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