Provider Demographics
NPI:1780398461
Name:SANDHILLS MEDICAL FOUNDATION, INC.
Entity type:Organization
Organization Name:SANDHILLS MEDICAL FOUNDATION, INC.
Other - Org Name:<UNAVAIL>
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:CEO
Authorized Official - Phone:803-900-6614
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 1:126 N PEARL ST
Practice Address - Street 2:
Practice Address - City:PAGELAND
Practice Address - State:SC
Practice Address - Zip Code:29728-1925
Practice Address - Country:US
Practice Address - Phone:866-737-4031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANDHILLS MEDICAL FOUNDATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-09
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)