Provider Demographics
NPI:1568541597
Name:SANDHILLS MEDICAL FOUNDATION, INC.
Entity Type:Organization
Organization Name:SANDHILLS MEDICAL FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:JAMES STANLEY
Authorized Official - Last Name:WARDLAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-335-8291
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:MC BEE
Mailing Address - State:SC
Mailing Address - Zip Code:29101-0366
Mailing Address - Country:US
Mailing Address - Phone:843-335-8291
Mailing Address - Fax:843-335-8731
Practice Address - Street 1:645 S. 7TH STREET
Practice Address - Street 2:
Practice Address - City:MCBEE
Practice Address - State:SC
Practice Address - Zip Code:29101
Practice Address - Country:US
Practice Address - Phone:843-335-8291
Practice Address - Fax:843-335-8291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC421826207Q00000X
261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCFQC005Medicaid
SC1881Medicare PIN
SCH90070Medicare UPIN
SCQ58456Medicare UPIN
SCFQC005Medicaid
SCQ31099Medicare UPIN
SCI43423Medicare UPIN
SC421825Medicare Oscar/Certification
SCB92652Medicare UPIN
SCQ51894NPMedicare UPIN