Provider Demographics
NPI:1538195029
Name:SANDHILLS MEDICAL FOUNDATION
Entity type:Organization
Organization Name:SANDHILLS MEDICAL FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NORWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:803-438-5537
Mailing Address - Street 1:40 BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:LUGOFF
Mailing Address - State:SC
Mailing Address - Zip Code:29078-9406
Mailing Address - Country:US
Mailing Address - Phone:803-438-5537
Mailing Address - Fax:803-438-5546
Practice Address - Street 1:40 BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:LUGOFF
Practice Address - State:SC
Practice Address - Zip Code:29078-9406
Practice Address - Country:US
Practice Address - Phone:803-438-5537
Practice Address - Fax:803-438-5546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC784674Medicaid
4226139OtherNCPDP