Provider Demographics
NPI:1689447534
Name:TANDEM HEALTH SC
Entity type:Organization
Organization Name:TANDEM HEALTH SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-774-4545
Mailing Address - Street 1:550 S. PIKE WEST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-2616
Mailing Address - Country:US
Mailing Address - Phone:803-324-6975
Mailing Address - Fax:803-324-6975
Practice Address - Street 1:200 W. CLARK ST.
Practice Address - Street 2:
Practice Address - City:PINEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29125-9998
Practice Address - Country:US
Practice Address - Phone:803-830-6184
Practice Address - Fax:803-774-4626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-02
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCFQC309Medicaid