MEDICARE: PRISMA HEALTH MEDICAL GROUP-MIDLANDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	152W00000X	Optometrist
2	207W00000X	Ophthalmology Physician
3	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1588389456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRISMA HEALTH MEDICAL GROUP-MIDLANDS

Provider Business Mailing Address
First Line	:	300 E MCBEE AVE FL 4
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2842
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 MEDICAL PARK RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6807
Country	:	US
Telephone Number	:	803-434-2020
Fax Number	:	803-434-1581

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KRISTI ANN LAWRENCE
Credential	:
Telephone Number	:	864-797-6118

Provider Enumeration Date	:	10/04/2022
Last Update Date	:	10/04/2022

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