Provider Demographics
NPI:1861504441
Name:SANDHILLS FAMILY MEDICINE, PC
Entity Type:Organization
Organization Name:SANDHILLS FAMILY MEDICINE, PC
Other - Org Name:HARTVIGSEN FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARTVIGSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-736-0731
Mailing Address - Street 1:3000 NE MEDICAL PARK
Mailing Address - Street 2:STE 101
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6251
Mailing Address - Country:US
Mailing Address - Phone:803-736-0731
Mailing Address - Fax:803-736-0753
Practice Address - Street 1:3000 NE MEDICAL PARK
Practice Address - Street 2:STE 101
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6251
Practice Address - Country:US
Practice Address - Phone:803-736-0731
Practice Address - Fax:803-736-0753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13110207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4509Medicaid
SC=========OtherGROUP TAX ID
SC8590Medicare PIN