1386902542 NPI number — SANDHILLS MEDICAL FOUNDATION, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386902542 NPI number — SANDHILLS MEDICAL FOUNDATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDHILLS MEDICAL FOUNDATION, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386902542
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 366
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MC BEE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29101-0366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-335-8291
Provider Business Mailing Address Fax Number:
843-335-8731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 W MARION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KERSHAW
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29067-1412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-475-4701
Provider Business Practice Location Address Fax Number:
803-475-4712
Provider Enumeration Date:
04/25/2012

Additional Information

Authorized Official

Authorized Official Last Name:
WARDLAW
Authorized Official First Name:
ERNEST
Authorized Official Middle Name:
JAMES STANLEY
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
843-335-8291

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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