Provider Demographics
NPI:1780640623
Name:SANDHILLS MEDICAL FOUNDATION
Entity Type:Organization
Organization Name:SANDHILLS MEDICAL FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:AMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-658-3005
Mailing Address - Street 1:409 E CHURCH ST
Mailing Address - Street 2:PO BOX 249
Mailing Address - City:JEFFERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29718-8701
Mailing Address - Country:US
Mailing Address - Phone:843-658-3005
Mailing Address - Fax:843-658-7780
Practice Address - Street 1:727 S 7TH ST
Practice Address - Street 2:
Practice Address - City:MC BEE
Practice Address - State:SC
Practice Address - Zip Code:29101-9011
Practice Address - Country:US
Practice Address - Phone:843-335-8291
Practice Address - Fax:843-335-8731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21527261Q00000X, 261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Not Answered261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCFQC005Medicaid
SC421825Medicare ID - Type Unspecified
SCH09795Medicare UPIN