Healthcare Provider Details

I. General information

NPI: 1083228779
Provider Name (Legal Business Name): SANDHILLS MEDICAL FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 MAIN STREET SOUTH
BETHUNE SC
29009
US

IV. Provider business mailing address

PO BOX 366
MC BEE SC
29101-0366
US

V. Phone/Fax

Practice location:
  • Phone: 866-737-4031
  • Fax:
Mailing address:
  • Phone: 803-669-3461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: ERNEST J WARDLAW
Title or Position: CEO
Credential:
Phone: 843-335-8291