1548757123 NPI number — SANDHILLS INTERGRATED CARE, INC.

Table of content: (NPI 1548757123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548757123 NPI number — SANDHILLS INTERGRATED CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDHILLS INTERGRATED CARE, 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:
1548757123
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 532
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28472-0532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-756-3008
Provider Business Mailing Address Fax Number:
843-756-3128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2406 MADISON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH MYRTLE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29582-4334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-663-0748
Provider Business Practice Location Address Fax Number:
843-663-0749
Provider Enumeration Date:
04/18/2018

Additional Information

Authorized Official

Authorized Official Last Name:
TROY
Authorized Official First Name:
LACHANDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
843-756-3008

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GP8411 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com