Age Well SC LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

AGE WELL SC LLC

Practice address

468 Old Cherokee Rd
Lexington, SC 29072-9031

Phone

(803) 646-0126

NPI assigned

Mar 5, 2025

Last updated

Mar 5, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tjuana Seidl, OWNER

Title

Director

Phone

(803) 646-0126

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ryan Wayne Seidl, PA-C

  • Physician Assistant
  • Lexington, SC
  • NPI 1821599143
  Medicare reassignment Care Compare group NPD
• Tjuana Faith Durden Seidl, PA-C

  • Medical Physician Assistant
  • Lexington, SC
  • NPI 1912378290
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1741132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741132800000",
    "number": "1003614900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "468 OLD CHEROKEE RD",
            "city": "LEXINGTON",
            "state": "SC",
            "postal_code": "290729031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "468 OLD CHEROKEE RD",
            "city": "LEXINGTON",
            "state": "SC",
            "postal_code": "290729031",
            "telephone_number": "803-646-0126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGE WELL SC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-05",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A",
        "authorized_official_last_name": "SEIDL",
        "authorized_official_first_name": "TJUANA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "803-646-0126",
        "authorized_official_credential": "OWNER"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sana Ahmad, DDS
• Layne Ailstock
• Vincent Albano, MS, ATC
• Melissa McCormick Albergotti, RDH
• Skylar Albers, PT, DPT

• Multi-Specialty Clinic/Center in Lexington, SC
• Providers in Lexington, SC by specialty
• Multi-Specialty Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.