Healthcare Provider Details

I. General information

NPI: 1962471946
Provider Name (Legal Business Name): PRISMA HEALTH MIDLANDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 FARROW RD STE 300
COLUMBIA SC
29203-7606
US

IV. Provider business mailing address

3010 FARROW RD SUITE 300
COLUMBIA SC
29203-7607
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-1210
  • Fax: 803-434-1212
Mailing address:
  • Phone: 803-434-1210
  • Fax: 803-434-1212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number StateSC

VIII. Authorized Official

Name: POLLY H MILLER
Title or Position: VP-FIN ENTERPRISER PAYOR CONTRACTIN
Credential:
Phone: 864-522-2286