Provider Demographics
NPI:1174387245
Name:SANDHILLS MEDICAL FOUNDATION, INC
Entity type:Organization
Organization Name:SANDHILLS MEDICAL FOUNDATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:WARDLAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-900-6612
Mailing Address - Street 1:40 BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:LUGOFF
Mailing Address - State:SC
Mailing Address - Zip Code:29078
Mailing Address - Country:US
Mailing Address - Phone:803-438-5537
Mailing Address - Fax:803-438-5546
Practice Address - Street 1:215 N. PEARL ST
Practice Address - Street 2:
Practice Address - City:PAGELAND
Practice Address - State:SC
Practice Address - Zip Code:29728
Practice Address - Country:US
Practice Address - Phone:803-438-5537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANDHILLS MEDICAL FOUNDATION, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy