Provider Demographics
NPI:1811973068
Name:TANDEM HEALTH SC
Entity type:Organization
Organization Name:TANDEM HEALTH SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:BROWN
Authorized Official - Last Name:GEDDINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-774-4500
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29151-0250
Mailing Address - Country:US
Mailing Address - Phone:803-774-4500
Mailing Address - Fax:
Practice Address - Street 1:25 E CLARK ST
Practice Address - Street 2:
Practice Address - City:PINEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29125-8989
Practice Address - Country:US
Practice Address - Phone:803-774-4516
Practice Address - Fax:803-452-5712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCFQC048Medicaid
SC372048Medicaid
SC7124Medicare ID - Type Unspecified
SC372048Medicaid
SC7124Medicare PIN