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Organization
AGE WELL SC LLC
Active
Organization
AGE WELL SC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TJUANA SEIDL OWNER (DIRECTOR)
(803) 646-0126
Entity
Organization
Contact information
Practice address
468 OLD CHEROKEE RD, LEXINGTON, SC 29072-9031
(803) 646-0126
Mailing address
468 OLD CHEROKEE RD, LEXINGTON, SC 29072-9031
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
NULL
363AM0700X
Medical Physician Assistant
—
NULL
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
03/05/2025
Last updated
03/05/2025
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